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The game's plot follows Toad, who is walking through what he assumes to be Toadstool's Garden. It is revealed, however that he has wandered into Wario's Woods and become lost, whilst Wario's monsters invade the Mushroom Kingdom. Wanda, Birdo and Toad all fight the monsters.
The game plays similarly to Tetris. Toad is the main hero, with Birdo and Wanda helping Toad by giving him encouragement and bombs to destroy the monsters (respectively). If Toad took too long to complete a level, the rascal Wario would grab Birdo and replace Wanda with a Pidgit. The two would then throw more monsters at Toad. Many enemies unique to this game appear, most notably the Evil Ceiling.
The game includes a two-player versus mode. Monster types, initial height, and drop speed can be adjusted before the match. The first player clearing the playing field from monsters or crushing the opponent wins the round. A best-of-five system decides the overall winner. Wins and losses of the two players are tracked persistently with four save states available.
- Clearing diagonal lines causes the big block to rise on your side. A line of three causes it to rise by one row, a line of four by two, etc.
- Clearing lines of four causes the opponent's block to drop by one row, five by two, etc.
- Clearing a line of five or more causes a crystal of a color (possibly the one with the least monstes on screen) to appear. Destroying the crystal causes all the monsters of its color to disappear.
- Chain reactions cause the big block to rise on your side and cause a column of monsters of a color to appear on the opponent's side.
- Clearing two (or more) lines simultaneously causes an egg (or more) to appear on the opponent's side. If the egg hatches, a row of monsters of a specific color will appear.