West of Elkton, US 33 Business (Old Spotswood Trail) splits to the north. US 33 then crosses the South Fork of the Shenandoah River, enters the town limits, and crosses over the Norfolk Southern rail line for the last time. The highway leaves the town at US 340 (East Side Highway) and the east end of US 33 Business. The route then follows West Swift Run southeast to the hamlet of Swift Run, after which it reduces to two lanes and begins a curvaceous ascent of the Blue Ridge, cresting the mountain at Swift Run Gap at an elevation of , where the highway crosses the Appalachian Trail and has an intersection with the access road to the Skyline Drive, the north–south highway through Shenandoah National Park, then descending to the Virginia Piedmont.