| Simms Fork | rises in W Yancey County and flows S into Elk Wallow Creek. |
| Simon Branch | rises in central Cherokee County and flows SE into Morgan Creek. |
| Simon Branch | rises in N Macon County and flows SW into Little Tennessee River. |
| Simpson | town in E Pitt County. Inc. 1923; post office est. 1888 as Chicod. Name changed in 1960. Alt. 63. |
| Simpson Branch | rises in SW Union County and flows S into South Carolina, where it enters Cane Creek. |
| Simpsons Store | community in W Rockingham County served by post office, 1879-1902, which operated in Patrick Simpson's store. |
| Simpsonville Township | S Rockingham County. |
| Sims | town in NW Wilson County, was settled before 1908, when a post office was est. Inc. 1913 as Simms; named for W. W. Simms. Reincorporated in 1923 as Sims. A large stone quarry is nearby. |
| Sims Creek | rises in S Watauga County and flows SW into Boone Fork. |
| Sincerity | community in NE Union County on Richardson Creek. |