Butcher Creek is a small settlement named after the creek, which runs southeast of Elysian Pool in Roanoke Ridge, across the Kamassa River. The settlement is made up of several small cabins near the shore of the river.
In the mission "That's Murfree Country", if Arthur and Charles decide to canoe some of the way to Beaver Hollow, they enter Butcher Creek. Upon arrival, Arthur remarks that the locals don’t seem very friendly, as they are met with warnings that the area is Murfree country. Due to it being night, the pair steal a pair of hitched horses and continue on to Beaver Hollow.
As part of the Stranger mission "The Wisdom of the Elders", the protagonist rescues Lemuel and brings him back to his friend Obediah Hinton at Butcher Creek. The protagonist returns later and finds the settlement under attack by mangy dogs, or demons according to the villagers, which the player proceeds to exterminate. A white man in native American clothing called The Shaman says that there is a curse on the village and that the player must destroy the nearby charms in order to lift it.
After doing so, the player returns to Butcher Creek. The Shaman says that this will have made things worse, but, annoyed at his blatant duplicity, the protagonist chases him off. Hinton recalls an abandoned mine near Elysian Pool, so the player investigates it. Once inside, the Shaman collapses the entrance and seals the player in the mine, although they manage to escape. When the protagonist returns to the village, they see the Shaman telling Obediah that signing a document will lift the curse forever. Obediah begins reading it aloud, revealing its an absolution of wrongdoings on the part of the mining company, which shocks the Shaman, who thought the entire town was illiterate and promptly asks Hinton to stop.
The protagonist appears and forces the Shaman to consume water from the abandoned mine; under duress, he reveals that the "curse" was actually lead and arsenic poisoning from the nearby mine leaking into the water supply, and admits that he was sent by the Roanoke Fuel Company to get the villagers to legally absolve them of wrongdoings. With the scheme foiled, the villagers still believe they are cursed. Obediah tells the player to take the money ($50), which they may do so before leaving the village without affecting their honor.
- To the southwest is a derelict wagon. Under this can be found chewing tobacco.
- There is a house to the north. Check inside the tree stump in the back to find hair tonic.
- A Pig Mask can be found hanging on the northeastern corner post of the slaughterhouse shed in the middle of the village.
- The Slouch Bucket Hat, Worn Stovepipe Top Hat, Bag Hat and Roanoke Hat can be found here, worn by some of the inhabitants.
- On a barrel on the front porch of the southeastern most house is the Cigarette Card for the Butcher Brothers.
- Sparrow Egg Orchids can be found scattered throughout the area.
- Follow the trail east and then north to come to the Roadside Brothel. Under the chair on the front porch is a Female Fertility Statue.
- South of the Roadside Brothel and across the trail is the Roanoke Ridge Van Horn Bone, sticking of the ground in a clearing.
- A pentagram appears underneath the burned down house during certain times at night.
- There is a deformed man in Butcher Creek who plays the banjo on his porch. The man is seemingly based on a real life person.
- Like in Van Horn Trading Post, if players commit a crime or use firearms in Butcher Creek, the inhabitants will become hostile and attack them. Moreover, killing inhabitants, even in in self-defense, will result in losing honor.