Its alignment, a narrow, winding road, greatly differs from US 74 today, straying from its parent route by as much as ~14 miles, separated by as much as half an hour of driving time.

US 74A traverses through downtown Asheville, goes through the mountain resort communities of Chimney Rock and Lake Lure, continues to Ruth, passes between the towns of Rutherfordton and Spindale, and bypasses Forest City to the south.

[1] US 74A is concurrent with US 64 from Ruth in the east through Lake Lure, where NC 9 joins, and Chimney Rock; the three routes separate in Bat Cave.

[2] US 74A begins at an interchange with US 19, US 23, I-40, and mainline US 74 in west Asheville, and briefly assumes the name Smokey Park Highway before becoming Patton Avenue, a major thoroughfare in the city.

Its concurrency with this route is brief, lasting for only a few miles in order to cross the French Broad River and bypass most of downtown Asheville.

It proceeds through the census-designated place and unincorporated community of Fairview, becoming a two-lane road and encountering several curves and bends, before entering Henderson County.

In the town, it assumes a concurrency with US 64 and NC 9; this is the former route's first interaction of many with US 74 in Western North Carolina when heading west.

Not long after leaving Bat Cave, US 74A enters Rutherford County and the resort town of Chimney Rock.

[3][4][5] US 74A travels through the community's downtown area, lined with shops and providing access to Chimney Rock State Park.

After leaving the town, the road briefly stops paralleling the Broad River for approximately 5.6 miles, and instead winds along the shores of Lake Lure, also encountering the community of the same name.

This road was a critical link for settlers in this region of Western North Carolina, as the rivers were not navigable and railroad service was still decades into the future.

Hickory Creek had been rerouted by the rains, necessitating sections of the road to be reworked and relocated due to the stream cutting through the former roadbed.

Not long after, the Lake Lure Dam was built, submerging parts of the original road and necessitating another reconstruction of these segments.

[5] US 74A received its current designation when the mainline US 74 was relocated to a new, mostly limited-access route between Forest City and Asheville via Hendersonville and I-26.

This relocation, which followed previous changes such as a freeway upgrade in 1970 that bypassed Mooresboro, Ellenboro, Forest City, and Spindale, completed the twinning of the route and rendered the original alignment obsolete.

US 74A is the site of North Carolina's first and longest-lasting Adopt-A-Highway program, started in 1988 by local residents of Gerton at the Upper Hickory Nut Gorge community center.