Many villages along the course of the river take their names from it, including Up Exe, Nether Exe, Exwick, Exton and Exminster. The seaside town of Exmouth is at the east side of the estuary, and Dawlish Warren at the west.
Tides on the river are now limited at Countess Wear (or Weir), which was constructed by the Countess of Devon. A ship canal bypasses the weirs and enabled ocean-going sailing ships to reach Exeter quay. At high tide, the estuary forms a large body of water that is heavily used for water sports especially sailing, wind surfing and water skiing; at low tide, extensive mud flats are exposed, and these are an important feeding source for wading birds. Along with other rias in south-west England, the Exe estuary is an important site for wintering waders. Dawlish Warren is a favoured site for birdwatching.