The song is about a truck driver named Charlie who is retiring after thirty years to spend more time with his wife.

The song mentions Charlie receiving a gold watch, a common retirement gift.

In 2024, Rolling Stone placed "Eighteen Wheels and a Dozen Roses" at #176 on its 200 Greatest Country Songs of All Time ranking.

The video opens with Mattea dining at the Pie Wagon, a diner off Music Row in Nashville, when a truck driver approaches her and asks for her autograph as a present for his wife.

In the end, the driver makes it home, his wife greeting him, and he hands her the dozen roses mentioned in the song's lyric, as they walk arm in arm into their house; Kathy turns off the lights to the bus, and the video ends with a shot of various trucks driving on the highway.