[1] The North River's headwaters comprise two streams that converge in the southeastern hollows of South Branch Mountain (3028 ft) in Hardy County.

The North River continues to flow east as a shallow stony stream and after it passes through a gap in Short Mountain (2864 ft), it acts as the border between Hardy and Hampshire counties.

The river then enters exclusively into Hampshire County where it meets the community of Rio and Sperry Run, which flows in from the south.

The North River crosses under the Bloomery Pike (West Virginia Route 127) and is then joined from the west by Crooked Run before flowing under Gaston Road's one-lane bridge and finally arriving at its confluence with the Cacapon River at Forks of Cacapon.

Since the early settlement of Hampshire County, the North River had been considered unnavigable by locals and experts alike.