Mackay Island National Wildlife Refuge was established on Knotts Island in 1960 as a winter haven for migratory birds. In the winter, the refuge focuses on marsh and water management to provide food for thousand of swans, ducks, and geese inhabitants. In the spring, the refuge opens its trail system for visitors to view the huge variety of watebirds and songbirds.

A canoeing/boating access leads to 20 miles of canals used for bird watching, fishing and photography. The refuge has one auto tour route and two hiking and bicycling trails. Fishing is allowed in impoundments, canals, and other water areas, subject ot North Carolina fishing regulations.

Mackay Island is located in the extreme northeast corner of North Carolina, some portions of the refuge extend into Virginia.

To get to the refuge directly by highway, follow Princess Anne Road 11 miles south of Pungo, Va (near Chesapeake, VA).