The river supplies the nearby town of Glacier, Washington with hydroelectric power from a dam on the North Fork near Nooksack Falls. The Middle Fork was partially blocked with a diversion dam built by the City of Bellingham in the late 1950s for diverting water into Lake Whatcom, which supplies the city's drinking water. As of July 2020, this old water diversion system has been modified to remove the dam and restore the river channel for the benefit of critical salmon spawning habitat.
