The river flows through a predominantly rural area, with small cattle, sheep and dairy farms. The largest town in the Otter Valley is Honiton. Tourism and leisure play important roles in the economy. For much of its length, the river flows through two Areas of Outstanding Natural Beauty (AONBs) - The Blackdown Hills AONB (to the north of Honiton) and East Devon AONB (to the south of Ottery St Mary).