Approximately 20 miles (32 km) northwest of Welch, it briefly forms approximately 4 miles (6 km) of the state line between West Virginia (northeast) and Virginia (southwest).

It joins the Levisa Fork at Louisa, Kentucky to form the Big Sandy.

Toponymist George R. Stewart writes about the origin of the name "Tug Fork".

In 1756 a small army of Virginians and Cherokees conducted the Sandy Creek Expedition against the Shawnee.

Later they returned and, being out of provisions, took the hides and cut them into thin strips called "tugs".