The Elk River is a large stream in the North Carolina High Country and East Tennessee.

[1] The headwaters begin from the Northwestern slopes of Peak Mountain in Avery County, North Carolina and end at the Watauga River in Carter County, Tennessee.

It then flows down a narrow, relatively steep valley to the tiny community of Elk Mills, which is named for a former water-powered mill built on this river at this point by early white settlers.

Between the state line and Elk Mills, it flows over Twisting Falls, a drop of approximately 30 feet (nine m).

This project has flooded the actual site of the original confluence of the Elk and Watauga rivers.