Mackay Island National Wildlife Refuge is an 8,219 acre parcel located on Knotts Island. The refuge is a popular spot for bird watching, bicycling, photography, fishing, and kayaking. Home to many endangered and threatened species, including peregrine falcons and American bald eagles, Mackay Island is also an important wintering area for thousands of ducks, geese, and swan. Visitors can often view wading birds, shorebirds, and raptors, as well as a variety of reptiles and amphibians, within the refuge. There is one auto tour route and two hiking and bicycling trails that provide access to the refuge, as well as 20 miles of canals that wind through the swamp-like habitat.

From mainland Currituck, visitors can reach Knotts Island and Mackay Island via a 45-minute ferry ride across the Currituck Sound. For a more indirect route, automobiles can travel through a section of southeastern Virginia and wind their way to the islands via land.