The region is rather flat and agricultural, however it does feature some rolling hills on the western edge.
Of all the creeks and rivers, the Big and Little Sioux Rivers, along with the Des Moines and Floyd are major in this region.
A smaller river known as the Rock River, which begins in Minnesota and flows to the Big Sioux should not be confused with the Rock River in Wisconsin and Illinois, which is a major river.
The region is rather rural, with Sioux City being the largest city at 83,000 (2013).
Major cities include Spencer, Orange City, Cherokee and Estherville.