This line was built in 1880s as a part of the Cape Fear & Yadkin Valley Railway. The original CF&YV route ran all the way from Wilmington, NC to Mount Airy, NC, with a branch from Fayettville to Bennettsville, SC. This company entered receivership in 1894. In 1899, Southern bought the portion from Sanford to Mount Airy and organized the Atlantic & Yadkin Railway to run it. The Atlantic Cost Line took over the remainder of the line from Sanford to North Wilmington and the Fayetteville to Bennettsville, SC line. Southern operated the line until 1916, when the A & Y gained a degree of autonomy as a Southern subsidiary. The Southern Railway merged the A & Y in 1950 and took over operations on the line.

The Southern abandoned the portion from just west of Rural Hall to northern Greensboro in the 1970s. This line passed through Germanton, Walnut Cove, Belews Creek, Stokesdale, and Summerfield, before entering Greensboro near the Guilford Courthouse battleground. The highway bridge over the former ROW still exists in Summerfield, but the one in Belews Creek was removed in the last year or two. The right of way is still apparent, though overgrown with woods, on Kernersville Road between US 158 and NC 65 near Belews Creek as a deep cut the intersects the road at a 90 degree angle. The former right of way goes right through the middle of town in Stokesdale. A portion of the right of way near Battleground Park in northern Greensboro has been converted into an asphalt trail, with plans to extend this up to Summerfield. The old trestle over the lake here burned several years ago, but a new pedestrian bridge has been added. The portion of the old A & Y from Rural Hall to Mount Airy is operated by the Yadkin Vally Railroad, and the portion from northern Greensboro to Sanford is still operated by Norfolk Southern. It is not known when industrial spurs in Greensboro associated with the old A & Y were abandoned.

A spur from Stokesdale formerly went to Madison where it connected with the Norfolk & Western. This section was abandoned sometime between 1937 and 1944.

Two personal stories about this line: A guy I work with has lived in Greensboro his whole life. He grew up in a house very close to the portion of the A & Y along Battleground Avenue in northern Greensboro (abandoned section). He vividly remembers seeing steam locomotives on this line in the 1940s, and he especially remembers seeing his first diesel locomotive on this line during the same time period. When he saw it he ran inside to ask his mother what it was. The other story has to do with personal friend who was an obstetrician in Kernersville. One day in the 1930s he was making a house call in the Oak Ridge/Summerfield area while it was snowing. The snow got so deep that he could not drive his car back to Kernersville, so he boarded the A & Y passenger train in Summerfield, road it to Greensboro, then boarded a Southern train and took it to Kernersville.