The river rises at  above sea level in western Augusta County, below Dyers Knob on Shenandoah Mountain along the Virginia-West Virginia border. From the man-made Elkhorn Lake it flows south and then east through the George Washington National Forest.
The river originates at an elevation above sea level in western Augusta County, situated below Dyers Knob on Shenandoah Mountain along the Virginia-West Virginia border. From the artificial Elkhorn Lake, it flows south and then east through the George Washington National Forest.