Two Tennessee Valley Authority reservoirs in Carter County — each impounded behind TVA Watauga Dam (forming Watauga Lake) and TVA Wilbur Dam (forming Wilbur Lake) — are located southeast and upstream of Elizabethton on the Watauga River. The Appalachian Trail crosses over both the Watauga River and the Tennessee Valley Authority reservation in Carter County to the southeast of Elizabethton.

The Watauga River flows past Elizabethton. Elizabethton lies on the south bank of the Watauga and along either side of its principal tributary, the Doe River. The downtown business district is located approximately one-quarter mile upstream of the confluence of both the Doe River and the Watauga River. The Doe River flows underneath the historic wooden covered bridge that is located within the Elizabethton downtown business district.

The Bee Cliff Rapids — a popular summer destination on the Watauga River for whitewater rafters during the summer months — are located southeast of Elizabethton and downstream of the TVA Wilbur Dam.

The Watauga River downstream of the western side of Elizabethton has one of the only two sections of trophy trout streams across the entire state of Tennessee.