Choosing one of three fighters, Cody, Guy or Mayor Mike Haggar, you make your way through the streets of Metro City battling the forces of the street gang MAD GEAR in order to rescue Cody's girlfriend Jessica the daughter of the mayor from Belger, the evil leader of the gang.

Final Fight can be played by up to two players simultaneously, with each player controlling a different character. Before the game begins, the player chooses between the three main characters, Guy, Cody, and Haggar, each with his own fighting style and attributes. Guy is the weakest but has faster attacks, Haggar is the strongest but also the slowest, and Cody has all-round attributes.

Final Fight consists of six stages or "rounds", as well as two bonus rounds. Each round takes place in a different section of Metro City such as the Slums and the Subway, with most rounds featuring more than one level. At the end of each round the player will face a boss character unique to that round.