Aerial Assault is set in 2015, where the terrorist organization NAC is rapidly conquering the world. As a renegade fighter pilot from the Freedom unit, you must take on the NAC threat and destroy their forces. The game features similar mechanics to the Sega Master System version, with the player navigating through stages shooting air, ground, and naval enemies while collecting power-ups. Each mission consists of two or three stages, culminating in a final boss battle.
The gameplay involves flying through levels, destroying enemy targets, and collecting power-ups to gain an advantage. The Aerial Assault on the Sega Game Gear features fast-paced action and challenging levels, requiring players to use their skills and strategy to succeed.