For most of the river's course, it runs in a deep gorge. Just before the Elk River crosses into Tennessee it flows over "Big Falls" (also called "Elk Falls"), a locally-known attraction which is approximately a 60-foot (18 m) drop.
The river primarily follows a narrow, steep-sided channel for most of its journey. As it approaches the border with Tennessee, it cascades down "Big Falls" (also referred to as "Elk Falls"), a well-known spot featuring an approximately 60-foot (18 m) descent.