Middle Caicos is about 15 miles long and 5 miles at its widest point. With a total land area of approximately 48 square miles, it is the largest of all the Turks and Caicos Islands. Despite its size Middle Caicos has the second smallest population in the country with some 270 residents. Traditionally, residents of Middle Caicos were farmers with some engaging in construction and some fishing to supplement diets. There is still good bonefishing in the waters around Middle Caicos.

Today, most of the younger residents of the island are moving to Providenciales in search of jobs and the island does not have the critical mass to offer tourists the activities that can be found on larger tourist destinations, or even Providenciales. Middle Caicos is therefore an island suited to the visitor who is interested in unwinding in a beautiful surroundings. With a dramatic coastline, the island has a natural and rugged beauty.

Middle Caicos is known for its interesting system of caves, beautiful beaches, spectacular cliffs and coastline, and its significant archeological sites, on what was probably a principal settlement of Lucayan Indians in the sub tropics. Archeologists have found among other things, a ball court, a variety of beads, and some tools. Evidence of Lucayan settlements on the island dates back to as early as 750 AD. It is believed that as many as 4,000 Lucayan Indians might have inhabited Middle Caicos at one point. Archeologists have discovered at least 38 Lucayan Indian sites on Middle Caicos.

The caves in Middle Caicos are located behind the Conch Bar settlement and there is another system between Bambarra and the Lorimers settlement. The caves are home to colonies of bats, stalactites, stalagmites, and a species of shrimp. The cave system also has underground fresh water subterranean lakes and some salt water lagoons that are connected to the ocean. The Conch Bar caves in particular, are the largest caves in the Caribbean. The cave system in Middle Caicos comprises a system of multilayered caverns. Recent excavations in the caves uncovered the bones of large tortoises, extinct birds, a five foot iguana, pottery, and other artifacts. It is recommended that a guide be used if the caves are to be explored extensively.

There are three settlements on the island: Conch Bar, Bambarra, and Lorimers. Conch Bar, which is the largest settlement, is located along a one mile stretch on a slight elevation along King's Road. The entire settlement overlooks the ocean, giving most of the residents of Conch Bar a breathtaking view of the coral encrusted waters to the north of the settlement. Conch Bar is home to the airport, the government school, most of the hotels and guesthouses, the island's famous caves, and the breathtaking rock formation of Mudjin Harbour, just one mile to the west of Conch Bar. Mudjin Harbour is a large opening in a cliff wall, just a few yards away from the ocean. The protruding cliff and nearby casuarina pine trees provide shade, making the area perfect for romantic picnics or for taking photos.

Bambarra is the second largest settlement in Middle Caicos. It is located east of Conch Bar and it is the only settlement in the Turks & Caicos Islands with an African name. The area was settled by the crew of a Spanish slave boat that sunk in 1842. The settlement is characterised by tall casuarina pine trees. Bambarra is about half a mile inland, at the northern end of Middle Caicos. The beach in front of the settlement is the site of the island's yearly regatta celebration: Middle Caicos Expo. The celebration takes place in mid-August around the thatched huts that line the beach in front of Bambarra. These huts function as stalls for vendors of crafts and food. The regatta features a beauty pageant, a tug of war, sailing boat races, and domino competitions.

Lorimers is the third settlement, and it is located at the northeastern end of Middle Caicos, east of Conch Bar and Bambarra. Lorimers is the smallest of the three Middle Caicos settlements, but the residents are proud, happy, and friendly.

The southern half of Middle Caicos is comprised of swamp and tidal flats.  The Government has designated this portion of Middle Caicos a nature reserve. It is home to a frigate bird breeding colony, bonefish, and a blue hole with turtles and even some sharks. The blue hole was formed when a cavern, about two hundred feet underground, collapsed. The Ramsar Convention for the protection of lobster, water birds, flora, and fish nurseries has designated the area a wetland of international importance.