The state Department of Transportation described the storm damage as "a scar on western North Carolina" and shared video showing blocked roads, downed trees and other flooding.
Gov. Roy Cooper declared a state of emergency earlier in the day and said that about 250 rescuers had been deployed after Haywood and Transylvania counties saw up to 12 inches of rain overnight, resulting in flooding. And "unconfirmed reports" said storm-related water levels may have risen 3 to 7 feet in areas, he said.
"Overnight, approximately 98 people were rescued as river flooding happened quickly," Cooper wrote in a Twitter thread. "Reports of missing people continued overnight and today."
Thirty-five people were missing in Haywood County, according to the local sheriff's department, and about a dozen bridges were "damaged or destroyed."
County officials were offering emergency food and shelter to displaced residents, and anyone with pets was asked to bring a leash and crate along with food and meds for their animals.
In Transylvania County, Fred dumped roughly 17 inches of rain over three days in some areas, according to the Transylvania Times.
In Yancy County, officials imposed a curfew Tuesday night to keep residents indoors during the worst of the flooding, FOX Carolina reported. Buncombe County saw blocked roads and residents displaced.
The state Department of Emergency Management warned that flooding can still happen even after the rain stops.
"It is never safe to walk or drive through floodwaters," the agency said in a statement. "It only takes a few inches of water to cause a driver to lose control of a vehicle. A foot of fast moving water can carry a car away."
More rain is forecast later in the week, even as the post-tropical cyclone Fred breaks up Wednesday night. At the same time, Tropical Storm Henri was closing in on the East Coast and was nearing hurricane strength.
That storm was about 235 miles southwest of Bermuda and headed west at 9 mph as of 5 p.m. Henri was packing winds of 70 mph and expected to send storm swells toward the East Coast later this week.
"North Carolina is all too familiar with devastating flood events, and we will continue to monitor and provide support from the state level," Cooper tweeted. "Our prayers are with those families and businesses affected, and we want to thank everybody involved in rescue efforts."