Its western endpoint is at Kuwohi, where it connects to the Appalachian Trail in the Great Smoky Mountains National Park.

Its eastern endpoint is in Jockey's Ridge State Park on the tallest sand dune on the east coast.

The vast majority of the foot trail is located on lands not directly managed as part of a state park unit.

The MST has the distinction of being the highest elevation long-distance trail in the eastern United States as it crosses Mount Mitchell at 6,684 feet (2,037 m).

In some areas, hikers can cross the BRP boundary lines into the Nantalhala and Pisgah National Forests to camp at well-established campsites.

Planning is being done to create designated, private campsites for the MST on parkway land, but the only backpack site currently[when?]

On the North Carolina Piedmont section of the MST, camping is not permitted along the Sauratown Trail section (from Pilot Mountain to Hanging Rock State Parks) since the trail is managed and maintained on land leased from private landowners.

A list of nearby campgrounds and lodging is maintained on the Sauratown Trails Association website.

Large sections of the Falls Lake State Recreation Area and neighboring public lands managed by the Army Corps of Engineers also prohibit camping.