The Elk Fork of the Salt River is one of the most scenic fishing streams in northeast Missouri. This river is lined with limestone bluffs, bedrock outcroppings, and overhanging streamside trees. The fishing habitat includes deep pools broken up by gravelly riffles and beds of water willow. It is a great wade-fishing stream but can be fished by canoes, kayaks, and small boats for anglers who don't mind walking short distances. The best fishing water is immediately upstream of Union Covered Bridge, then downstream through Cedar Bluff Access to Mark Twain Lake.
Smallmouth bass and channel catfish are common throughout its length. Smallmouth bass are abundant but most fish will be less than 12 inches. Crappie and walleye are known to run up the Elk Fork from Mark Twain Lake and some stay in the river throughout the summer. Other species such as green sunfish, largemouth bass, common carp, buffalo, and white bass are also present, but are less abundant.