Heads at the confluence of the North Fork Roanoke River and South Fork Roanoke River in Montgomery County; flows generally southeast into North Carolina, where it enters the west end of Albemarle Sound. The segment of the stream between John H. Kerr Dam upstream to the mouth of Back Creek is often known locally as the Staunton River; the Board on Geographic Names (BGN) 1959 decision authorized the use of that name parenthetically for that section.
First named Hocomawananch by the Indian population; name Rorenock was applied by European settlers in 1670. Col. Cadwallader Jones labeled it the Occaneechi River on his 1693 map; labeled Staunton River on 1727 survey of Virginia-North Carolina boundary. An Indian word designating a kind of shell used for money.