The late fiddler Ed Haley played a tune called "Three Forks of Sandy" that had three parts to it, one each for the Tug Fork, the Levisa Fork, and the Big Sandy main stream. The Tug Fork originates in McDowell County, while the Levisa and its tributaries rise no more than 20 miles away in southwest Virginia. The two forks flow generally northwestward and parallel to each other. They join at Louisa, Kentucky, to form the Big Sandy River, which then flows to the Ohio River at Catlettsburg. The valley is about 190 miles long and 80 miles wide, with the Tug Fork and then the Big Sandy forming the entire length of the West Virginia-Kentucky state line. Major towns on the Big Sandy watershed include Williamson and Kenova, West Virginia, as well as Pikeville, Louisa, and Catlettsburg, Kentucky.

This is an area of thick forest, rugged terrain, and bituminous coal mining, and a hotbed of Scotch-Irish, English, and German culture. Roads came slowly. For generations the most practical means of transportation and the main contact with the rest of the world was by river. The Big Sandy Valley saw some of the Civil War, with the battles of Middle Creek and John's Creek probably being the most memorable. The most famous event in the valley's history was the Hatfield-McCoy feud, which raged along Tug Fork in the 1880s.

Steamboat traffic proliferated roughly from the 1830s to the eve of World War II, bringing needed things to isolated areas, moving passengers and mail back and forth, and carrying out produce to be sold. Some were sternwheelers, and some had exposed sidewheels and were called "bat wings." Steamboats traveled the entire length of Big Sandy and up the Levisa as far as Pikeville. When the water was too low, poled wooden flats called "pushboats" took over and went as far upstream as Williamson, on the Tug Fork.

Temporary splash dams were built on the Russell Fork of Levisa and other tributaries, to form pools to collect logs so that they could be floated out when the dams were dynamited and the waters released. The logs were collected downstream. The late Capt. Jesse P. Hughes said he remembered being almost able to walk across the mouth of the Big Sandy entirely on log rafts at Catlettsburg. Many of these rafts were towed down the Ohio, some as far down as Cincinnati, where much of the lumber went into the building of the palatial steamboats that graced the Mississippi and Ohio during this period.

The late Bob Kennedy, of Kenova, said 25 steamboats were based up the Big Sandy before the railroads arrived. Both banks were lined with landings, wharfboats, and warehouses to handle the upriver commerce all the way to Pikeville, mile 88.5 above Louisa. Probably the largest steamboat was the Argand, but she operated only at high stages of water. Captain Hughes ran the sternwheel Cricket for many years. In later years there were three locks and dams on the Big Sandy and one each on the Tug and Levisa. The last log raft down the Big Sandy originated on the Levisa in about 1942 or '43 and actually passed through Lock 1 on that stream. Today, nine miles of the Big Sandy are commercially navigated.

The Norfolk & Western Railroad was built down the Tug Fork and Big Sandy in the late 1880s, connecting the valley by rail to the Midwest and to the coal-shipping docks of Norfolk. Thereafter, mining the region's rich deposits of bituminous coal became the main economic activity of the Big Sandy watershed, and it remains so today. Rail and highway transportation gradually displaced the riverboats.