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On June 26, 2019, Ayers was hired as an assistant coach for the Phoenix Suns.

He was inducted into the Ohio Basketball Hall of Fame in 2013.

Ayers was named head coach of the Philadelphia 76ers on June 20, 2003, after serving as an assistant coach with the team since 1997. He compiled a 21–31 record, but was fired in the middle of the season. He then served as an assistant coach for the Orlando Magic. On July 24, 2007, Ayers was hired as an assistant coach for the Washington Wizards. On August 5, 2009, Ayers returned to the Philadelphia 76ers to serve as an assistant coach under Eddie Jordan. Ayers then joined the coaching staff of the New Orleans Hornets (now Pelicans) in 2010, continuing his position until 2012. He returned with the Pelicans for the 2014–15 NBA season before being hired as a scout for the Brooklyn Nets on November 3, 2015.

Ayers married Carol Denise Peery of Columbus, Ohio on June 18, 1983. She is a high school Spanish teacher. They have two sons. Ryan Vincent (born July 16, 1986) was a student at the University of Notre Dame, a member of the Fighting Irish basketball team, and now is an assistant coach at his alma mater. Cameron Alexander (born September 18, 1991) played college basketball at Bucknell University and currently plays for the Reno Bighorns of the NBA Development League. Ayers' youngest brother, Tim Ayers, served as mayor and city commissioner of Springfield, Ohio from 1984 to 1990.

Ayers earned a bachelor's degree in Education from Miami in 1978, and in 1981 he earned a master's in Education.

He was drafted in the third round of the 1978 NBA draft by the Chicago Bulls, but was cut from the team and then played professionally in Reno, Nevada for the Reno Bighorns in the fledgling Western Basketball Association. Ayers earned second-team all-league honors, but the WBA folded after one season.

Ayers began his coaching career at his alma mater, Miami University, in 1978, before moving on to the U.S. Military Academy and Ohio State. His first head coaching position came at Ohio State in 1989, taking the Buckeyes to the top regional seed in the NCAA men's tournament in both 1991 and 1992, but never reaching the Final Four. He was named National Coach of the Year in 1991, and Big Ten Conference Coach of the Year in 1991 and 1992.

In his senior year of 1977–78, Ayers increased his scoring average for the third straight year with 13.4 ppg and had 7.0 rpg. He was named second-team All-MAC as his teammate, Archie Aldridge, earned MAC Player of the Year. Ayers was also named Miami's Defensive Player of the Year. Miami's record was 19-9 but they earned an outright MAC championship and earned a berth in the NCAA tournament. Miami opened the tournament with a thrilling 84-81 overtime win over defending national champion Marquette, a game in which Ayers had a double-double with 20 points and 10 rebounds plus three assists. In the next round they were defeated by eventual national champion Kentucky, 91-69, although Ayers had another big game with 18 points, eight rebounds and three assists.

As a junior in 1976–77, Ayers increased his scoring average to 12.8 ppg and 8.1 rebounds per game (rpg) as, for the third season, he was named honorable mention All-MAC. The Redskins posted an overall record of 20-6 and were MAC co-champions.

As a sophomore in 1975–76, Ayers became a starter and averaged 10.9 ppg as the team finished 18-8 and second in the MAC. He was again named honorable mention All-MAC.

Ayers was born in Springfield, Ohio, the fourth of eight children of Frank Ayers and Betty Basey. He played basketball at North High School in Springfield, where he was named Ohio high school Class AAA (big-school) player of the year in 1974.

Ayers attended Miami University in Oxford, Ohio, where he played basketball. Ayers made his mark more as a defender, rebounder and playmaker than as a scorer, as Miami teammates Archie Aldridge as well as Chuck Goodyear provided much of the offense. As a freshman in 1974–75, Ayers saw significant playing time, averaged 8.5 points per game (ppg) with a .560 field goal percentage as the Redskins, coached by Darrell Hedric, posted a 19-7 record. He was named honorable mention All-Mid-American Conference (MAC)

Randall Duane Ayers (born April 16, 1956) is an American basketball coach. He is currently an assistant for the Phoenix Suns. His son Ryan is an assistant coach for the Notre Dame Fighting Irish Men's Basketball team.