The game itself features two gameplay modes: Survival mode and sandbox. In survival mode, the player is first tasked with creating a character and then surviving as long as possible in either Muldraugh or West Point in Knox County. The sandbox mode allows players to change various gameplay mechanics of the game such as the speed and numbers of zombies inhabiting the world, and weather conditions and item availability within the world.
Additionally, the game features a set of 'challenge' scenarios, which are unique compared to the traditional gameplay of survival. This includes last stand mode, where the player must survive against either waves of zombies or a steady flow of zombies, earning cash for killing zombies that they can spend on ammunition and weapons. When creating a character the player must choose a profession, each with its own perks, and then choose the character's traits. Each trait has a points value assigned to it, either positive or negative, depending on if it is a good trait or a bad one.