The U.S. West Coast exhibits large variability of extreme precipitation during the boreal winter season (December–February). Understanding the large-scale forcing of such variability is important for improving prediction. This motivates analyses of the roles of sea surface temperature (SST) forcing and internal atmospheric variability on extreme precipitation on the U.S. West Coast. Observations, reanalysis products, and an ensemble of Atmospheric Model Intercomparison Project (AMIP) experiments from phase 5 of the Coupled Model Intercomparison Project (CMIP5) are analyzed. It is found that SST forcing only accounts for about 20% of the variance of both extreme and nonextreme precipitation in winter. Under SST forcing, extreme precipitation is associated with the Pacific–North American teleconnection, while nonextreme precipitation is associated with the North Pacific Oscillation. The remaining 80% of extreme precipitation variations can be explained by internal atmospheric dynamics featuring a circumglobal wave train with a cyclonic circulation located over the U.S. West Coast. The circumglobal teleconnection manifests from the mid- to high-latitude intrinsic variability, but it can also emanate from anomalous convection over the tropical western Pacific, with stronger tropical convection over the Maritime Continent setting the stage for more extreme precipitation in winter. Whether forced by SST or internal atmospheric dynamics, atmospheric rivers are a common and indispensable feature of the large-scale environment that produces concomitant extreme precipitation along the U.S. West Coast.