From the town of Saltville downstream there is an exceptional smallmouth bass fishery. It routinely produces smallmouth up to five pounds. Sunfish, rockbass, carp, and channel catfish fishing are also good. This river is still under a health advisory from mercury contamination. Fishing is allowed, but the fish must not be consumed.

A 20-inch minimum size limit is in effect for smallmouth bass in the North Fork Holston River from the Route 91 Bridge, upstream of Saltville, downstream to the Tennessee State line. All smallmouth bass less than 20 inches must be released. One smallmouth larger than 20 inches may be kept per angler per day. This regulation should protect and enhance the trophy smallmouth fishery that has developed in this river.

Population samples collected in 2003 and 2004 revealed very good numbers of smallmouth in several sections of the river. Trophy smallmouth bass were collected in most of the sections sampled. Smallmouth abundance is about average compared to other Virginia rivers. However, the proportion of smallmouths from 14 to 18-inches long is much higher than in most other rivers. Sunfish, channel catfish, flathead catfish, carp, and suckers were also collected. A couple of new angler access sites have been developed near the town of Saltville.