Rambo: The Video Game is a first-person shooter based on the three Rambo action movies starring Sylvester Stallone. It consists of a series of sequences from the three movies in chronological order, preceded by a flashback tutorial level set in Vietnam. The gameplay is based around the rail shooter concept and does not offer freedom of movement. The camera guides the player through the levels while the player moves the cross-hair in a first-person view to take out enemies. These are often combined with non-lethal takedowns using quick time events. In those sections, the player is encouraged to shoot hands and legs to disarm opponents instead of killing them directly. Sometimes the two gameplay concepts are combined in stealth sections.
The game requires the player to kill lots of enemies and rewards them with a multiplier for linking kills. Some enemies have an exclamation mark over their head and need to be killed quickly, or their shots are lethal. The game also features a cover system through arrows on the screen, active reload for double ammunition, and a kill cam for precise shots.
Fighting Rambo builds up a wrath meter that once activated, time slows down, there is unlimited ammo, and enemies glow orange and provide health when killed. By killing people and completing sections, experience is earned to assign skill points and unlock perks. Up to three perks can be assigned simultaneously.
The game offers two-player local cooperative multiplayer games, allowing players to team up with a friend to complete the campaign.