Titanium alloys are widely used in various industries. The most common and well-known titanium alloy is titanium alloy with aluminum and vanadium (Ti-6Al-4V). This alloy is used, for example, in the manufacture of aircraft engines. As part of the development of technologies and the emergence of the evolving requirements for materials, Ti-6Al-4V alloys with ultrafine grains less than 1 μm may become promising. This modification of the alloy has excellent strength characteristics, such as increased fatigue resistance. However, manufacturers are aware of the machinability problem of titanium alloys. To date, a sufficiently high level of understanding of this problem has already been achieved. But, there is practically no information about the machinability of ultrafine-grained alloys and their comparison, in this regard, with the usual coarse-grained version. This study presents the results of experimental studies on the influence of cutting parameters (cutting speed, V, m/min; feed rate, Fz, mm/rev) on the roughness and microstructure of the surface of Ti-6Al-4V samples with coarse-grained and ultrafine-grained structures produced via equal-channel angular pressing. It is shown that turning at a low cutting speed (V = 48 m/min) results in a better surface roughness, Ra, for the coarse-grained sample compared to its ultrafine-grained alloy counterpart. When the cutting speed is increased by 1.5 times (up to V = 72 m/min), on the contrary, the ultrafine-grained sample has a lower surface roughness, Ra, compared to the coarse-grained sample. The differences in the morphology and microstructure of the chips, depending on the microstructure type of the processed alloy, are discussed: the presence of plastic flow lines in the chip microstructure of the turned ultrafine-grained sample and the formation of shear bands, cleavages, and microcracks in the chips of the turned coarse-grained alloy.