The Meadow River is a major tributary of Gauley River. It has its headwaters along the Greenbrier-Summers county line, in the high mountains northwest of Alderson. From there the Meadow River flows in a northwestward direction to join the Gauley just downstream from Summersville Lake and near Carnifex Ferry Battlefield State Park.

Meadow River rises at an elevation of 3,945 feet and enters the Gauley River at 1,182 feet, for a total descent of 2,763 feet. The lower section of Meadow River, much of which is located within the Gauley River National Recreation Area, is a rocky, turbulent stream. The Meadow is 52.6 miles long, with a watershed of 371.3 square miles. From near Rainelle to its mouth, the Meadow River forms the boundary between Fayette and Greenbrier and Fayette and Nicholas counties.

The rich hardwood timber lands of the Meadow River watershed were harvested in the late 19th and early 20th centuries. The logging of the region had awaited the arrival of railroad transportation, just after 1900, since the rocky river was unsuitable for log drives. The Meadow River Lumber Company operated one of the biggest sawmills in West Virginia at Rainelle until 1970.

Rainelle and Rupert are located in the Meadow River Valley, as are many smaller communities. The major tributaries of Meadow River are Anglins, Brackens, Glade, Meadow, Sewell and Little Sewell, and Big Clear and Little Clear creeks. The Meadow River is followed for several miles in Greenbrier County by U.S. 60, the historic route of the James River & Kanawha Turnpike, and the river is paralleled for most of its length by a railroad. Interstate 64 intercepts the headwaters of Meadow River at Dawson, Greenbrier County.