From Stung Treng
Access to Koh Preah island is by small ferry (1000 riel/0.25c one way) located an hour’s drive from Stung Treng. Turn off National Road 7 at Red Mountant Road (GPS 13.388662,106.0820398) and the ferry dock is another 20 minutes from here. From Stung Treng a direct tuk-tuk costs $20 and takes about one hour to reach the ferry (GPS 13.3017992,105.9136956).
Alternatively, you can hop on a bus to Kratie (arranged with your guest house) and ask to be dropped at the intersection of Mountant Road and National Road 7 for the Koh Preah ferry.
From the ferry stop on the island, a pre-arranged motodop ($1.25 US) takes about 5 minutes to reach the other side of the island and to where the homestays are.
Easier, but pricey:
For $80, a private boat can be arranged to pick you up directly from Stung Treng. Boats carry up to 20 people and take 1-2 hours.
From Kratie:
This is probably your best option. Take a local bus to Stung Treng ($5-$10) and ask to be dropped at the intersection at Mountant Road and National Road 7. From here you can take a tuk-tuk or motodop to take you to Koh Preah ferry. Otherwise stay on the bus until Aur Pour Moan, a well frequented bus station where all buses coming from Stung Treng and Ratanakiri stop. Here you are certain to find a tuk-tuk or motodop that can take you to the ferry.
Departure:
Motodops ($2.50 USD) can be arranged from the island ferry north to Aur Pour Moan. From here it’s easy to hop on a bus west to Stung Treng, east to Ratanakiri or retrace your steps south to Kratie. Buses shouldn’t cost more than $5-$7.
Boats south along the Mekong:
Private boats can be arranged to pick you up directly from the island heading south on the Mekong. Boats from Koh Preah to Sambour (close to The Koh Pdao Homestay) take 3 5 hours and cost $100 for four people.