A Ressha de Ikou MD is a simulation game involving the construction of a railroad in order to boost the city's mass transit system. The game was released to an exclusively Japanese market; with no release ever being attempted for the North American or European markets.

The player must use the resources at hand to build a railroad connecting the two ends of a map in each scenario. A train can be controlled throughout the day (05:00-17:00) while building new tracks and stations. Nighttime activities (17:00-05:00) involve changing train schedules to better suit the needs of the player's growing mass transportation hub. New developments will spring up around the tracks and stations. This permits the player to increase the amount of money that can earn; resulting in the increased ability to build railroad tracks and stations for the growing city. Five scenarios offer a tutorial mode for first-time players, an extremely hard scenario for veterans, and three more scenarios for players in between the two extremes in difficulty levels. Players can play using speeds that range from slow to normal to fast.