The game follows the movie's story. The player, controlling Rambo, has to find his lost equipment, locate the POW camp, rescue the hostages and make it back to the extraction point, while being pursued by constantly respawning enemies. Rambo starts off with just a Bowie knife and grenades (both of which have an unlimited supply, as with all the weapons), and gains points for killing the enemy, and for collecting the following equipment: Rocket Launcher, M16 Rifle, and Bow & Arrows (Explosive & Non Explosive).
The gameplay is based on Capcom's arcade game Commando (1985).