The river source lies just west of Buxton. It then flows east, along a route roughly followed by the A6 road. It enters the Peak District, flows just south of Tideswell, then through Ashford in the Water and Bakewell, and south of Haddon Hall, before meeting the River Derwent at Rowsley.
A pleasant walk is possible alongside much of the length of the river, mostly following an abandoned railway line.
The main tributary of the river is the River Lathkill, which enters approximately one mile from its mouth.