The highway connects mostly rural areas of Bell County with Middlesboro.

KY 186 begins at the Tennessee state line southwest of Middlesboro, within Bell County, where the roadway continues as Fork Ridge Road.

It travels to the northeast, paralleling Bennetts Fork, and curves to the east-northeast to enter Middlesboro.

The highway has an intersection with the southern terminus of KY 3502 (Winchester Avenue).

They both end at an intersection with KY 74 (West Cumberland Avenue).