Russell Fork begins where several small streams meet near Council, Virginia, and, like other Appalachian Plateau rivers, flows through a narrow V-shaped valley where flash floods are not uncommon. Its major tributaries include McClure River and Russell-Prater Creek at Haysi, Virginia, and especially Pound River just north of Bartlick. The stream drains all of Dickenson County and parts of Wise and Buchanan counties in Virginia, covering 554 square miles above Elkhorn City, Kentucky, just downstream, before joining Levisa Fork at Millard, Kentucky. Levisa Fork and Tug Fork then meet at Louisa, Kentucky, forming the Big Sandy River, which enters the Ohio River at Catlettsburg, Kentucky. Native American names associated with this watershed include Chatterwha for the Big Sandy and Ouasioto for these highlands, and both names have also been applied to Russell Fork. Russell Fork is internationally known for whitewater, especially in the gorge through the center of Breaks Interstate Park, where the river drops nearly 280 vertical feet from Garden Hole upstream of the Towers to this point, running over bare bedrock and around large boulders beneath cliffs 800 to 1000 feet high. John W. Flannagan Reservoir and North Fork of Pound Dam and Lake, completed in 1964 and 1966 as flood control projects on Pound River, make controlled releases from Flannagan Reservoir possible, assuring prime whitewater conditions on October weekends each year, though the river's character can change markedly at other times depending on precipitation.