You play as two high school students, Alex and Ryan, as they cross River City in an attempt to rescue River City High and Ryan's girlfriend Cyndi from the clutches of a villain called "Slick". Along the way, they battle with gangs of students and several gang leaders.
In addition to being a beat 'em up, River City Ransom has RPG elements with the game being open world. The combat is very similar to Double Dragon and objects can be used as melee or projectiles.
However, the effectiveness in battle, is determined through their stats and their knowledge of fighting techniques, purchased through books from shops.
Defeated gang members drop loot which can be used to buy books, food, and spa treatments which may increase stats. Passwords are used to keep track of your character's progress. There are 9 gangs to fight, each with different characteristics.
The game received generally positive reviews. GamesRadar ranked it the seventh best NES game of all time.