Middle Fork of the American River is the strong silent sibling of the three American River branches. But not the uggliest, and compared to the South Fork American River, it's a toss-up as to which one maintains much of it's pristine character.
Based on historic access in the early 1900s the Middle Fork was split geographically into two National Forests. The Tahoe National Forest essentially on the north and the Eldorado National Forest essentially on the south. This discussion concentrates on the Tahoe NF on the north side of the river.
Beginning in Foresthill, the Mosquito Ridge Road provides a scenic drive up the dramatic basin to the Placer Big Trees, the small but northern-most grove of Giant Sequoia. Grouse Falls are nearby and make a worthwhile side-trip.
Oxbow Dam provides regulated releases creating whitewater rafting and kayaking adventures. The road down to the dam and the small Ralston Reservoir provide the perfect put-in for one of the best whitewater runs in California. The stretch of river is also the best fishing in the river.
For mapping purposes, the headwaters of the Middle Fork lie within the Granite Chief Area and the lower section of the river cuts through the Auburn State Recreation Area.