It flows approximately 12 miles (19 km) from its source, the confluence of two streams running off Kinder Scout in the Peak District, east through Edale and then southeast through the village of Hope.

The entire length of the river is closely followed by the Hope Valley (Manchester to Sheffield) railway line.

One example of this was the cotton mill at Edale; built in the late 18th century it shares a common design with other mills of the period, including multiple floors with large windows and a shallow pitched roof.

There was also a corn and saw mill at Hope, driven by an 11 ft water wheel.

This was constructed to provide additional inflows for Ladybower Reservoir by the Derwent Valley Water Board.