The Appalachian and Ohio operates 158 miles of rail line, between Grafton and Cowen, WV. Coal is the primary commodity the A&O transports, from the several coal mines it serves. Other freight includes logs, lumber, and chemicals. The Appalachian and Ohio interchanges with the CSXT at Grafton, WV.
It also connects with three short line railroads: the BEEM at Alexander, WV; the ELKR at Burnsville Junction, WV; and the WVC at Tygart Junction, WV.