The game takes place in a treacherous sewer system filled with various obstacles and enemies, including rats, bats, spiders, and other nasties. The sewers are divided into three types: solid floors, water passages, and pits. Sam can move around by walking, running, or creeping through the tunnels, but he's slower in water.
As Sam navigates the sewer system, he receives a fresh supply of oxygen each time he enters a new sewer. The ultimate goal is to destroy the Russian submarines located only in water canals. The game features a status bar that displays the distance Sam has traveled into the sewer, and scoring increases with each nasty element shot.