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It rises in the Appalachian Mountains of southwestern Virginia, in eastern Buchanan County, near Grundy. It flows west into Pike County, Kentucky, where it receives the Russell Fork River and is impounded to form Fishtrap Lake reservoir, then northwest past Pikeville and Prestonsburg. At Paintsville it turns to the NNE, flowing through Johnson and Lawrence counties. It joins the Tug Fork from the southwest at Louisa on the West VirginiaWest Virginia is a state of the United States, known as The Mountain State. While many consider it part of the South, many in the state's Northern Panhandle feel a greater affinity for Pittsburgh, while those in the Eastern Panhandle feel a greater affini state line to form the Big Sandy.
The river is partly navigable for commercial purposes through a series of locks.
Kentucky rivers Virginia rivers