NC 18 is a predominantly two-lane rural highway that travels 145.5 miles (234.2 km) in western North Carolina.

[2][3][4] Entering Morganton from the southeast, it crosses under I-40 (exit 105) and follows Sterling Street into the downtown area.

Near the Catawba River, NC 18 connects with mainline US 64 at Sanford Drive and continue as a shared concurrency into Caldwell County.

[6] After passing through Thankful and Boomer, it joins NC 16 at Moravian Falls, then goes north towards Wilkesboro.

After passing through Mulberry, Halls Mill and McGrady, NC 18 takes its ascent along a curvy stretch of highway into Alleghany County.

Crossing the Little River, at Blevins Crossroads, NC 18 goes easterly, near the Virginia state line.

North of Cumberland Knob, NC 18 crosses under the Blue Ridge Parkway again and enters Surry County.

Continuing on NC 89 will take travelers south to Mount Airy or north to Galax, Virginia.

[18] In 1978, NC 18 was rerouted again in downtown North Wilkesboro, from Forester Avenue to CBD loop.

In 2006, a major realignment in downtown Lenoir took place, eliminating US 321A; at that time signage for NC 18 Bus was removed, but the route was not decommissioned.

In December, 2012, NCDOT approved a change package that decommissioned the business loop and transferred control of the roads to the city of Lenoir.