The 177-mile Elk River meanders from its start in Pocahontas County, cutting through some of West Virginia's wildest areas before joining the Kanawha River at Charleston. Its watershed covers about 6.5% of the state.

The river is an important resource, providing drinking water for Charleston and many other communities. It is also an excellent place for fishing, known especially for large muskies.

The upper part of the Elk is a geological marvel: the river actually sinks underground in a six-mile stretch in Randolph County during dry weather, forming a network of caves and streams.

Historically, the middle and lower parts of the river often flooded. In 1961, the Sutton Dam was built, creating Sutton Lake and making decades of perennial flooding less of a problem.