Neuroshima Hex is played on a hexagonal board. Each player periodically draws from a deck of hexagonal cards called "tiles." Tiles symbolize different types of military units. Annotations on the tiles denote the combat strength of each unit. Each player has one special tile called HQ (headquarters). Players take turns placing their tiles on the board. The player chooses:

which tile from his hand to play,

where to place the tile on the board, and

what orientation the tile should have. Being hexagonal, there are six possible orientations for placing each tile.

Normally a card does not move once placed on the board. Periodically a tile is played that initializes combat. At that time, cards are removed from the board based on the outcome of combat between pairs of nearby opposing cards. The game is nominally concluded when all tiles from the deck have been exhausted. The winner is determined by which HQ has taken the least combat damage.