The western terminus of SR 243 is at a diamond interchange with the U.S. Route 52 (US 52) in Coal Grove.

The eastern terminus of the state highway is at its signalized junction with State Route 7 approximately 1.25 miles (2.01 km) west of Proctorville near the northern banks of the Ohio River.

[6][7] The western terminus was moved west to Coal Grove, concurrent with SR 7 through Proctorville, in 1932.

[8][9] The paving of the route between Coal Grove and Proctorville was completed by 1955.

[12] The entire route is in Lawrence County.