Elkhorn City, a southeastern Pike county town, was founded around 1810 at the confluence of Elkhorn Creek and Russell Fork of the Big Sandy River. Through the years the town was known as Elkhorn, Praise, and finally Elkhorn City. The Praise post office opened in 1882 and was renamed Elkhorn City in 1952. The population in 1990 was 813.

Breaks Interstate Park is located just east of Elkhorn City on the Kentucky-Virginia border.