In Fallout Extreme, players would control a squad of revolutionaries, utilizing both first- and third-person perspectives to engage in tactical combat. The gameplay would focus on squad-based mechanics, allowing players to strategize and coordinate their team's actions against various factions.

The storyline of Fallout Extreme unfolds in a post-apocalyptic world nearly a century after the Great War, where the Brotherhood of Steel expands its territory and poses a significant threat to survivors. Players would initially oppose the Brotherhood, gaining support from towns in the Pacific Northwest before embarking on a journey to thwart a catastrophic missile threat in China.

Fallout Extreme stands out with its ambitious narrative scope, featuring a diverse array of factions and a unique setting that extends beyond the traditional Fallout universe, exploring new territories and conflicts.