The game starts off with Colonel Trautman asking Rambo whether or not he wants to leave the prison and start the mission. Players are given a choice, but cannot advance in the game unless "yes" is chosen. Players advance through the camp and talk to others, and when talking to Trautman again, he tells Rambo the mission. Rambo then drops into the forest and fights spiders and other forest creatures. Bosses include giant spiders and helicopters. The game is noted for its identical gameplay to Zelda II: The Adventure of Link, in that the player can kill enemies for experience points and the layouts are similar. In the Japanese version, the experience meter is replaced by an anger meter, however, it functions exactly the same.
Later in the game, Rambo picks up an arsenal of weapons and fights enemy soldiers, but this happens close to the end of the game.
The ending sequence allows the player to throw a giant kanji character (怒, Ikari) towards Murdock after returning to the base, which inexplicably turns Murdock into a frog.
The USA version ends with a simple "End", but the Japanese Famicom version contains staff credits. It is unknown why this was left out of the USA version.
The game was seen as a disappointment from fans and received criticism for its lack of machine gun action similar to Contra, sluggish controls, complex password system, slow gameplay with unnecessary cut scenes, and confusing layout, similar to the game, Friday the 13th.
Additionally, notwithstanding the fact that the movie this game is based on was given an R rating, the North American version of the game contains swearing that managed to make it past Nintendo's censorship policies.