The accident happened after a tyre blew on the church bus which then crossed the road and hit oncoming traffic on Interstate 40 in Jefferson County.
The bus clipped an oncoming SUV and struck the truck, which burst into flames.
At least 14 people were hurt in the accident which shut down Interstate 40 in north-east Tennessee. Two were reported in a critical condition.
Several hours after the crash, clouds of smoke still rose from the truck and tree branches that lined the highway were charred.
Transport official Dalya Qualls said 18 people were on the bus and six of them were killed.
One person out of the three in the SUV was killed and the truck driver also died.
An emergency response official told WBIR-TV that 20 ambulances and five helicopters responded to the accident.
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