Flowing southwestward, the stream drains roughly 30 miles of the eastern slope of the Great Laurel Ridge, from the Pennsylvania Turnpike south to Confluence, a watershed of 125 square miles. Along that length it takes on at least three different personalities, offering anglers different kinds of challenges and rewards.

From the outflow of Laurel Hill Lake at Trent and downstream for several miles, ...

Laurel Hill is more like an average-size Pennsylvania stream. The current in much of this section is slow to moderate and road access is handy.

Just below, several smaller mountain brooks tumbling down from Forbes State Forest join the flow and Laurel Hill swells. From above Barronvale at the junction with Fall Creek, Laurel Hill flows for about 12 miles to Humbert. The stream churns through a remote and scenic gorge, dominated above Humbert by State Game Lands 111. Road access is sparse through this wild region, but anglers willing to walk to the water will find fish.

The lower section from Humbert to the Youghiogheny River is where Laurel Hill truly takes on the appearance of a river. The broad stream meanders through a wide valley with an almost uniform current and is rarely beyond sight of the road.

A 1.2-mile section runs from the footbridge on State Game Land 111 at Humbert, downstream to Paddytown Hollow Run. Another special regulation area stretches 2.2 miles at Laurel Hill State Park, just above Laurel Hill Lake. Both sections are marked with signs. No trout may be killed before June 15, and fishing with bait is prohibited.