All verified sites of occurrence are in the Cumberland Plateau Physiographic Province, giving it one of the most restricted ranges of any Cumberlandian species.

Cicerello and Laudermilk[2] maintains that these two species occur sympatrically in the Rockcastle River, contrary to the assertion by Gordon and Layzer[4] that they are allopatric.

Based on recent records, populations of the Cumberland elktoe persist in 12 tributaries: The latter nine streams, which comprise the Big South Fork system, may represent a single metapopulation of the Cumberland elktoe; there may be suitable habitat for the species and/or its fish hosts in intervening stream reaches, potentially allowing for natural genetic interchange to occur.

[9][10] Several age classes of the Cumberland elktoe were represented in samples taken from throughout the larger tributaries of the Big South Fork system in Tennessee during a 1985-86 survey.

[5][11] Gordon and Layzer[11] reported that the species appears to be most abundant in flats, which were described by Gordon[5] as shallow pool areas lacking the bottom contour development of typical pools, with sand and scattered cobble/boulder material, relatively shallow depths, and slow (almost imperceptible) currents.

Five native fish species were parasitized by Cumberland elktoe glochidia: However, under laboratory conditions, juvenile specimens transformed only on the northern hogsucker.