"The town isn't here anymore," said Sergio Pirozzi, the mayor of Amatrice.
The magnitude 6 quake struck at 3:36 a.m. (0136 GMT) and was felt across a broad swath of central Italy, including Rome, where residents felt a long swaying followed by aftershocks. The temblor was felt from the Lazio region into Umbria and Le Marche on the Adriatic coast.
The hardest-hit towns were Amatrice, Accumoli near near Rieti, some 100 kilometers (80 miles) northeast of Rome, and Pescara del Tronto further east. Italy's civil protection agency said the preliminary toll was 37 dead, several hundred injured and thousands in need of temporary housing, though it stressed the numbers were fluid.
More than 100 Kent State students in Italy at time of earthquake
Kent State student Mariel Zambelli spoke with NewsChannel 5 over Twitter after the earthquake.
Zambelli said the students were 150 miles away from where the earthquake hit. They didn't feel anything and all of the students were safe.
Zambelli said she received an email Wednesday morning from Kent State professors telling the students about the earthquake.
— Corrina Pysa (@CorrinaPysa) August 24, 2016
What happened to Amatrice?
The center of Amatrice was devastated, with entire buildings razed and the air thick with dust and smelling strongly of gas.
Rocks and metal tumbled onto the streets and dazed residents huddled in piazzas as some 39 aftershocks jolted the region into the early morning hours, some as strong as 5.1.
"The whole ceiling fell but did not hit me," marveled resident Maria Gianni. "I just managed to put a pillow on my head and I wasn't hit luckily, just slightly injured my leg."
Another woman, sitting in front of her destroyed home with a blanket over her shoulders, said she didn't know what had become of her loved ones.
"It was one of the most beautiful towns of Italy and now there's nothing left," she said, too distraught to give her name. "I don't know what we'll do."
As daylight dawned, residents, civil protection workers and even priests began digging out with shovels, bulldozers and their bare hands, trying to reach survivors. There was relief as a woman was pulled out alive from one building, followed by a dog.
"We need chain saws, shears to cut iron bars, and jacks to remove beams: everything, we need everything," civil protection worker Andrea Gentili told The Associated Press. Italy's national blood drive association appealed for donations to Rieti's hospital.
The devastation harked back to the 2009 quake that killed more than 300 people in and around L'Aquila, about 90 kilometers (55 miles) south of the latest quake. The town sent emergency teams Wednesday to help with the rescue.
"I don't know what to say. We are living this immense tragedy," said the Rev. Savino D'Amelio, a parish priest in Amatrice. "We are only hoping there will be the least number of victims possible and that we all have the courage to move on."
Who else was affected?
Another hard-hit town was Pescara del Tronto, in the Le Marche region, where the main road was covered in debris. The ANSA news agency reported 10 dead there without citing the source, but there was no confirmation.
Residents were digging their neighbors out by hand since emergency crews hadn't yet arrived in force. Photos taken from the air by regional firefighters showed the town essentially flattened.
"There are broken liquor bottles all over the place," lamented Gino Petrucci, owner of a bar in nearby Arquata Del Tronto where he was beginning the long cleanup.
The Italian geological service put the magnitude at 6.0; the U.S. Geological Survey reported 6.2 with the epicenter at Norcia, about 170 kilometers (105 miles) northeast of Rome, and with a relatively shallow depth of 10 kilometers (6 miles).
"Quakes with this magnitude at this depth in our territory in general create building collapses, which can result in deaths," said the head of Italy's civil protection service, Fabrizio Curcio. He added that the region is popular with tourists escaping the heat of Rome, with more residents than at other times of the year, and that a single building collapse could raise the toll significantly.
The mayor of Accumoli, Stefano Petrucci, said six people had died there, including a family of four, and two others. He wept as he noted that the tiny hamlet of 700 swells to 2,000 in the summer months, and that he feared for the future of the town.
"I hope they don't forget us," he told Sky TG24.
Blessings for the buried
In Amatrice, the Rev. Fabio Gammarota, priest of a nearby parish, said he had blessed seven bodies extracted so far. "One was a friend of mine," he said.
Pirozzi estimated dozens of residents were buried under collapsed buildings and that heavy equipment was needed to clear streets clogged with debris.
Premier Matteo Renzi's office tweeted that heavy equipment was arriving.
A 1997 quake killed a dozen people in the area and severely damaged one of the jewels of Umbria, the Basilica of St. Francis in Assisi, filled with Giotto frescoes. The Franciscan friars who are the custodians of the basilica reported no immediate damage from Wednesday's temblor.
Pope Francis skipped his traditional catechism for his Wednesday general audience and instead invited pilgrims in St. Peter's Square to recite the rosary with him.