A Ressha de Ikou MD is a real-time railroad simulation game, and part of the A-Train series from Artdink. Based on the first two games in the series, in each scenario the player must use the resources at hand to build a railroad connecting from one end of a map to the other. During the day, the titular "A-Train" can be controlled, by which the player can build tracks and stations. During the night, train schedules can be modified. As the player builds, development will spring up around the tracks and stations, bringing in income by which more tracks and stations can be built.

The game offers a total of five different scenarios of increasing difficulty, ranging from a practice scenario for beginners to very difficult scenarios for experienced players. There are also three different game speed settings available.