Download the Region
If you haven’t already downloaded them, see How to Download Regions for SimCity 4.
How to Use SimCity 4 Regions
Find the downloaded region file and make a new folder in that same folder, called something like SimCity Region (you don’t have to choose a particular name; anything will work). If the region is contained in a ZIP file, first open the archive and then extract the files to that folder. If it’s not in an archive, just copy the files to the folder you made. These files will most likely be a JPG and a BMP. Start a new region in SimCity. Import the downloaded region with the Shift+Alt+Ctrl+R keyboard shortcut. Choose the image file you downloaded and extracted from Step 2. Wait for the region to load.
These files will most likely be a JPG and a BMP.