WV 218 begins at a junction with US 19, in Marion County, just east of Worthington (north and east of the West Fork River). From its southern terminus it the route runs northerly along Helens Run for about until it reaches Idamay. From that census-designated place, the route continues northerly for about , until it reaches U.S. Route 250 (US 250 / Husky Highway) in Farmington.
