In the late 19th century, Pike County and bordering
Mingo County, West Virginia provided the setting for the
Hatfield-McCoy feud, a bitter feud waged between two feuding families between 1878 and 1891 that has become American history.
Flooding South Williamson is protected by a floodwall, built by the
US Army Corps of Engineers in response to a devastating flood along the Tug Fork River in 1977. There have only been three uses of the gates thus far; the first occurred in 2002 during a major flood in the region, the second in 2003, due to anticipation of the rising river getting higher, and the third occurring in 2025 when another major flood struck the town causing the Tug Fork to crest at levels not seen since the 1984 flood. Areas just outside of the floodwall in South Williamson were devastated by river water rushing into homes and businesses in and around the South Williamson area. The area's regional hospital, ARH Regional Medical Center was 4 feet shy of being devastated by the flood due to water getting dangerously close to overtopping the floodwall around the hospital. ==Healthcare==