North West River (which was formerly known as Fort Smith) is a town with over 250 years of history. It was in 1743 that French fur trader Louis Fornel established a year round trading post at present day North West River.

The English took over the territory as spoils of war in 1763 and the region's vast salmon and cod stocks to supply its navy. Settlement, however, didn't start until 1785, 10 years after Captain Cartwright began fishing and trading south of Hamilton Inlet. This first wave of European settlement lasted until 1835.

1836 marked the arrival of the Hudson's Bay Company. They established two main trading posts: one at Rigolet; the other at North West River. After buying out competing fur traders the Hudson's Bay Company enjoyed a trading monopoly that would last over 100 years. It also sparked a second wave of European immigration and settlement.

Between 1848 and 1860 the North West River trading post was under the charge of Donald A. Smith (later Lord Strathcona). During his tenure he expanded the number of trading posts and proved the viability of raising vegetables and livestock in North West River. This prompted settlers to do the same and many began harvesting crops of potatoes, turnips and other hardy vegetables.

The late nineteenth and early twentieth century saw a wave of exploration of the Labrador interior. North West River was often the starting point for such explorations. A.P. Low of the Geological Survey of Canada spent many months in North West River during his expeditions between 1893 and 1896.

Leonidas Hubbard, an editor for a New York outdoors magazine, also began his expedition into the interior waterways of Labrador from North West River. His ill fated trip with companion Dillon Wallace became the subject of several books and articles and prompted international attention to Labrador and its people. This also brought Mina Benson Hubbard (widow of Leonidas Hubbard) to North West River in 1905 to complete her husband's trek.

This period also saw the establishment of organized health care for Labrador. Sir Wilfred Grenfell, an English doctor, set up hospitals, nursing stations and boarding schools all along the coast. The organization he founded to support these endeavours, the International Grenfell Association (IGA) still exists as a foundation supporting health education and community projects within the area that Dr. Grenfell brought health care to nearly a century ago.

Grenfell was able to attract other doctors and nurses to come to Labrador to help with his cause. One such Doctor was Harry L. Paddon. In 1915, after having run the IGA hospital at Battle Harbour, Dr. Paddon established a cottage hospital in North West River. Over the years, this hospital grew to become one of the main centres for health care for the Labrador coast and along with a new boarding school and the continued expansion of the Hudson's Bay Company, helped North West River to become a thriving community.

The later half of the twentieth century saw the establishment of an air base at nearby Happy Valley-Goose Bay. This meant an abundance of jobs for many locals and an influx of people moving from coastal communities to the North West River/Happy Valley-Goose Bay region. Since this time, Goose Bay has become the economic hub of central Labrador. North West River has remained small in size, but its history has made it one of Labrador's more interesting communities.