Although she was a previously published novelist and had a successful Broadway play, Rand had difficulty finding a publisher for The Fountainhead. Macmillan Publishing, which had published We the Living, rejected the book after Rand insisted that they must provide more publicity for her new novel than they did for the first one. Rand's agent began submitting the book to other publishers. In 1938, Knopf signed a contract to publish the book, but when Rand was only a quarter done with manuscript by October 1940, Knopf canceled her contract. Several other publishers rejected the book, and Rand's agent began to criticize the novel. Rand fired her agent and decided to handle submissions herself.
While Rand was working as a script reader for Paramount Pictures, her boss there, Richard Mealand, offered to introduce her to his publishing contacts. He put her in touch with the Bobbs-Merrill Company. A recently hired editor, Archibald Ogden, liked the book, but two internal reviewers gave conflicting opinions about it. One said it was a great book that would never sell; the other said it was trash but would sell well. Ogden's boss, Bobbs-Merrill president D.L. Chambers, decided to reject the book. Ogden responded by wiring to the head office, "If this is not the book for you, then I am not the editor for you." His strong stand got a contract for Rand in December 1941. Twelve other publishers had rejected the book.
Rand's working title for the book was Second Hand Lives, but Ogden pointed out that this emphasized the story's villains. Rand offered The Mainspring as an alternative, but this title had been recently used for another book, so she used a thesaurus and found 'fountainhead' as a synonym.
The Fountainhead was published in May 1943. Initial sales were slow, but as Mimi Reisel Gladstein described it, sales "grew by word-of-mouth, developing a popularity that asserted itself slowly on the best-seller lists." It reached number six on The New York Times bestseller list in August 1945, over two years after its initial publication.
A 25th anniversary edition was issued by New American Library in 1971, including a new introduction by Rand. In 1993, a 50th anniversary edition from Bobbs-Merrill added an afterword by Rand's heir, Leonard Peikoff. By 2008 the novel had sold over 6.5 million copies in English, and it had been translated into several languages.