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It rises in the Appalachian Mountains of extreme southwestern West Virginia, in southern McDowell County, near the Virginia state line. It flows in a meandering course through the mountains generally northwest, past Welch. Approximately 20 mi (32 km) northwest of Welch, it briefly forms approximately 4 mi (6.4 km) of the state line between West Virginia (northeast) and Virginia (southwest). For the remainder of its course it forms part of the boundary between West Virginia (east) and Kentucky (west), flowing northwest past Williamson, West Virginia. It joins the Levisa Fork at Louisa, Kentucky to form the Big Sandy.
The river flows through an especially remote mountainous region in its upper course. The river valley between Pike County, Kentucky and Mingo County, West Virginia was the scene of the famous Hatfield-McCoy feud in the late 19th centuryAlternative meaning: Nineteenth Century (periodical ( 18th century — 19th century — 20th century — more centuries) As a means of recording the passage of time, the 19th century was that century which lasted from 1801- 1900. Events The Little Ice Age ended.