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's source is situated in western Augusta County, below Dyers Knob on Shenandoah Mountain, along the border with West Virginia. It then flows south and east through the George Washington National Forest, similar to how many other rivers in the region do.