In order to improve the wear resistance of 20CrMoH steel, different ultrasonic rolling forces (700 N, 1000 N and 1300 N) and passes (3 passes and 6 passes) were applied to perform ultrasonic surface rolling on 20CrMoH steel. The surface morphology, roughness, microstructure, microhardness, surface residual compressive stress and friction and wear properties of the samples before and after ultrasonic surface rolling were analyzed by scanning electron microscope, roughness tester, optical microscope, microhardness tester, X-ray stress analyzer, sliding wear tester of end-face type and 3D profilometer. Compared with the untreated sample, the properties of the samples processed by ultrasonic surface rolling were greatly improved, the surface appearance of material was significantly smoother, the roughness Ra decreased from 0.82 μm to 0.331 μm, the surface microhardness increased from 760HV0.2 to 856HV0.2, with an increase by 12.63%, and the surface residual compressive stress increased from –286 MPa to –565 MPa. The wear mechanism changed from predominantly abrasive and fatigue wear of untreated samples to predominantly abrasive and oxidative wear. The wear resistance of the sample was the best after 6 passes of ultrasonic surface rolling under the force of 1000 N. Compared with the untreated sample, the wear volume was reduced from 2.29 mm3 to 0.74 mm3, with a decrease by 67.69%. Ultrasonic surface rolling can effectively improve the surface quality of 20CrMoH steel samples, refine the surface grain structure, increase the surface microhardness and surface residual compressive stress, and significantly improve the wear resistance of the material.