MD 354 parallels the Pocomoke River, connecting eastern Wicomico County and northwestern Worcester with Snow Hill.

The remainder of MD 354 was completed in the late 1920s and early 1930s, with little change in the highway since.

Nassawango Road heads southwest from the junction toward Pocomoke State Forest.

After passing through more farmland, the state highway enters the town of Willards and intersects U.S. Route 50 (US 50, Ocean Gateway).

MD 354 continues north to its terminus at MD 346 (Old Ocean City Road), where Main Street continues north into the center of Willards.