Nearby localities include Nawa, Jasim and al-Harrah to the north, Izra and al-Shaykh Maskin to the east, Tafas and Da'el to the southeast, and Adwan and Tasil to the west and Jalin to the southwest.

[6] During Aramaean and Assyrian rule, once the neighbouring city of Ashteroth lost its prominence, Karnaim annexed its name, becoming the capital of the land of Bashan under the name Ashteroth-Karnaim.

[citation needed][dubious – discuss] During the Hellenistic period, the city was referred to as Karnein,[6] a place held sacred by its local inhabitants.

[11] A rivalry has since existed between the local fellahin who consider St. Job to be the patron of their town, and the descendants of the African slaves to whom Shaykh Saad was their saviour.

[13] In 1596 al-Shaykh Saad appeared in the Ottoman tax registers as Sayh Sa'd, being in the nahiya of Jawlan Sarqi in the Qada of Hauran.

[14] Gottlieb Schumacher surveyed the town in 1884, and recorded that it was "miserable looking place, containing about 60 huts built of stone and mud, many of them now fallen to ruin.

"[15] In a bid to bring Hauran under further centralization, in 1892 the Ottoman government of Damascus pressed for the completion of land registration in al-Shaykh Sa'ad—still the regional capital—as well in other major towns in the area.

[18] Another holy artifact in the town is the "Rock of Job," known in local folklore as the place where he sat when he was afflicted with the disease, and is housed inside a mosque dedicated to Nabi Ayyub.