The New River flows northward through North Carolina, Virginia, and West Virginia, making it one of the few major rivers in North America that defies the typical southerly flow pattern. Originating from the confluence of the North Fork and South Fork near Boone, North Carolina, the river enters the specified region through Ashe and Alleghany counties in North Carolina before crossing into Virginia at Mouth of Wilson in Grayson County. The river continues its northward journey through Carroll, Wythe, Pulaski, Montgomery, and Giles counties in Virginia before entering West Virginia, where it flows through Summers, Raleigh, and Fayette counties, eventually joining the Gauley River to form the Kanawha River near Gauley Bridge.

The paddling opportunities span approximately 200 miles through these counties, ranging from gentle Class I-II sections ideal for beginners to challenging Class III-V whitewater in the New River Gorge. In North Carolina, the Wagoner Road to US 221 Access section offers 13 miles of Class I paddling through pastoral farmland. Virginia's sections include the Foster Falls area with Class III rapids and the stretch from Claytor Dam downstream featuring Class I-II water suitable for recreational paddlers. The Lower New River in West Virginia, particularly from Cunard to Fayette Station, presents serious Class IV-V whitewater requiring advanced skills and proper safety equipment. Spring and early summer provide optimal water levels for whitewater sections, while late summer and fall offer more manageable flows for novice paddlers.

The river supports exceptional smallmouth bass fishing, with Virginia holding state records for both smallmouth bass (8 pounds, 1 ounce) and muskellunge (45 pounds, 8 ounces) caught from these waters. The New River also hosts the endangered hellbender salamander and fourteen rare plant species along its corridor.

Major access points include Wagoner Road Access in Ashe County, US 221 Access in Alleghany County, Foster Falls in Wythe County, Whitethorne and Peppers Ferry in Montgomery County, Pembroke and Narrows in Giles County, and multiple access points within New River Gorge National Park and Preserve in West Virginia. The New River Trail State Park in Virginia parallels 57 miles of river, providing additional recreational opportunities.

Designated as a National Wild and Scenic River in 1976, the New River corridor preserves significant historical sites including remnants of early settlements and industrial heritage. The iconic New River Gorge Bridge in Fayette County spans 876 feet above the water, serving as a landmark for the region.

Safety considerations include monitoring dam releases from Claytor Dam, which can rapidly change water levels downstream. The river has multiple portages around dams at Fries, Byllesby, Buck, and Claytor in Virginia. Multi-day trips are feasible throughout the system, with primitive camping available at designated sites in New River State Park in North Carolina and backcountry camping permitted along certain stretches in West Virginia's New River Gorge National Park and Preserve.