Pikeville, the seat of Pike county, was founded in 1823 on the Levisa Fork of the Big Sandy River and was named, like the county, for General Zebulon Pike. The town was always known as Pikeville, although the official name of the town and post office were Pike and Piketon at various times. The population in 2010 was 6,903.

Pikeville is home to University of Pikeville and a campus of the Big Sandy Community and Technical College.