Emergence of cities and road networks have characterised human activity and movement over millennia. However, this anthropogenic infrastructure does not develop in isolation, but is deeply embedded in the natural landscape, which strongly influences the resultant spatial patterns. Nevertheless, the precise impact that landscape has on the location, size and connectivity of cities is a long-standing, unresolved problem. To address this issue, we incorporate high-resolution topographic maps into a Turing-like pattern forming system, in which local reinforcement rules result in co-evolving centres of population and transport networks. Using Italy as a case study, we show that the model constrained solely by topography results in an emergent spatial pattern that is consistent with Zipf’s Law and comparable to the census data. Thus, we infer the natural landscape may play a dominant role in establishing the baseline macro-scale population pattern, that is then modified by higher-level historical, socio-economic or cultural factors.