Known for most of its length as Exeter Road, the state highway runs 6.13 miles (9.87 km) from the Lee–Wise county line near Keokee, where the highway continues west as SR 606, east to U.S. Route 23 Business (US 23 Business) in Appalachia.

The roadway continues west into Lee County as SR 606 through Keokee toward Pennington Gap.

East of Lower Exeter, the state highway parallels a rail line that serves the coal mines in the valley.

At Pigeon Creek's confluence with Looney Creek, where the streams enter the Powell River, SR 68 curves north across the rail line, crosses the rail line that parallels Looney Creek, and meets the eastern end of SR 160 (Inman Road).

The state highway continues into the town of Appalachia as Inman Street, which crosses over Norfolk Southern Railway's Appalachia Division before reaching its eastern terminus at US 23 Business (Main Street).