Dudley, Sandwell, Walsall and Wolverhampton have all been placed under Tier 3 restrictions for when the national lockdown ends on December 2 and the same rules will apply across Staffordshire, where Lichfield, South Staffordshire, Stafford and Cannock Chase have also gone into the highest alert level.
Birmingham has also been put into Tier 3, as have Solihull and Coventry - which has the region's lowest infection rate at 198.4 cases per 100,000.
Meanwhile, Worcestershire, Shropshire and Telford & Wrekin, and Herefordshire will all be in Tier 2.
The restrictions are due to start next Wednesday and are set to be reviewed on a regular basis, with the first review understood to be due on December 16.
To determine restrictions, the Government used case rates, the number of cases among over 60s, the rate at which cases are rising and falling, positivity rates and pressures on local hospitals.
Many MPs and council leaders in the Black Country and Staffordshire said the toughest rules were frustrating but inevitable, but mayor Andy Street called for clear evidence behind the decision to shut down the region's hospitality sector.
Wolverhampton South West MP Stuart Anderson said: “I would love us to be in Tier 1, but realistically that can’t happen yet as our rates are still high. This is a race against the clock, and if everyone sticks to the rules then we can get into Tier 2 on December 16."
Explaining the decision, the Department for Health and Social Care (DHSC) said that while cases rates were "improving" in Birmingham and the Black Country, they remained "very high", leading to pressure on the NHS.
It was the same across Staffordshire, where the DHSC said there was "very high" pressure on local hospitals, including in units treating the most serious cases.
Announcing the new system in the Commons, Health Secretary Matt Hancock said across the country cases were down by 19 per cent in a week and hospital admissions had fallen by seven per cent.
But he said it was too early for the country to "go back to normal", and that tough restrictions were required for many areas in order to save lives and protect the NHS.
Under Tier 3, household mixing in any settings, both indoors and outdoors, is banned, while pubs and restaurants must close except for takeaway.
All indoor entertainment venues must also close, and the ban on fans for sports events continues.
Tier 2 rules state no household mixing indoors, while the rule of six applies in all outdoor settings. Pubs and restaurants must shut by 11pm and alcohol can only be served alongside a substantial meal.
Political leaders in the Black Country and Staffordshire said they were disappointed with the decision, with many of them hoping for a drop down from Tier 3 when measures are reviewed.
Councillor Patrick Harley, leader of Dudley Council, said the announcement would bring "frustration to many people in our borough", adding that he was "personally disappointed" that it does not reflect "the substantial reduction in our Covid-19 cases we have seen in recent days".
He said: "I will be urging the Government to continually review the situation and stand by their promises to take another look in two weeks’ time.
"In the meantime it’s vital that we all continue to follow the Government restrictions."
Dudley South MP Marco Longhi said the restrictions were "necessary", and that he would be lobbying the Government to increase its funding to support key industries.
Stourbridge MP Suzanne Webb said Tier 3 measures were "unavoidable" given infection rates. "I know the vast majority of people stick to the rules, however hard the restrictions are, because it will protect their community," she said.
"I will be asking ministers to make sure Stourbridge can come out of Tier 3 as soon as infection rates start to lessen."
In the seven days up to November 21, Dudley had the highest infection rate in the region – and 9th highest in the country – at 423.2 cases per 100,000 people, after 1,361 new cases were recorded.
Sandwell was one place behind on 418.6 per 100,000 (1,375 cases), followed by Wolverhampton, 352 (927 cases); Birmingham, 342.5 (3911 cases); Walsall, 332.8, (950 cases); South Staffordshire, 322, (362 cases); and Stafford 331.4 (455 cases); Lichfield 315 (330 cases); and Cannock Chase 255.1 (257 cases).
The tiered system will be relaxed for five days over Christmas, when up to three households will be able to mix indoors in all areas.
Only the Isle of Wight, Cornwall and the Isles of Scilly have been placed in the lowest Tier 1 set of restrictions, with people in all other parts of England set to face more serious limits to their freedom.
Lichfield MP Michael Fabricant said he regretted Staffordshire going into Tier 3 and recognised how "damaging" the move would be for businesses.
He said: "There is now a very clear light at the end of this gloomy tunnel with Covid vaccine becoming available next month and through the first quarter of 2021.
"We will then be able to return to near normal life. In the meantime, we must all try and stay safe and not recklessly endanger the lives of others."
He also urged people not to "run wild" over Christmas, adding: "If infection rates do not rise, but continue on their downward path, there is a chance that Staffordshire will drop to Tier 2 when this is reviewed."
Councillor Patrick Farrington, leader of Stafford Borough Council, urged people to stick to the rules so that the highest tier restrictions can be lifted "as soon as possible".
Sandwell Council's deputy leader, Councillor Maria Crompton, said the authority would continue to do everything possible to support local people and business through the hard times.
"Our messages have been consistently about keeping ourselves, our loved ones and our whole community safe," she said.
"The more we concentrate on that, the sooner we will see infection rates falling and restrictions relaxing. We have to be realistic – the situation remains very dangerous here."
West Midlands Police and Crime Commissioner David Jamieson said the decision was "a cruel blow" for people in the region who had "already sacrificed so much".
“I know the overwhelming majority will follow the rules as they have until now and for that I am extremely grateful," he added.
"I’d also like to reassure people that West Midlands Police will continue to support and help people to follow the new rules."