KY 290 begins at an intersection with KY 3630 in Annville, heading north on a two-lane undivided road. The route heads through a mix of farmland and woodland, coming to an intersection with the northern terminus of KY 578. A short distance later, the road intersects KY 2003. KY 290 continues through more rural areas, heading into the Daniel Boone National Forest. After passing through several miles of dense forest, the route heads into McKee and reaches its northern terminus at an intersection with US 421 in the downtown area.