During the political protests of the Saffron Revolution in Burma, ruthless SPDC officer Major Pa Tee Tint leads his Burmese Army forces in a campaign of fear. His soldiers pillage settlements, sadistically slaughter innocents, abduct teenage boys to be drafted, and hold women hostage to be raped as sex slaves.
Meanwhile, 20 years after the events in Afghanistan, Vietnam War veteran John Rambo is still living in Thailand, making a living as a snake catcher and providing boat rides. Michael Burnett, a missionary doctor, attempts to hire Rambo to ferry his group up the Salween River into Burma on a humanitarian mission to provide medical aid to a village inhabited by the Karen people. Rambo initially refuses, then agrees when convinced by Michael’s fiancée Sarah Miller.
During the trip, the boat is stopped by pirates demanding Sarah in exchange for passage, forcing Rambo to kill them. The missionaries arrive at the village but are attacked by Tint’s forces, who take Sarah, Michael, and other survivors prisoner. The pastor of the missionaries’ church comes to Thailand and asks Rambo to lead a team of five mercenaries on a rescue mission. Rambo takes the mercenaries to the drop-off point and offers to help, but Lewis, a former SAS soldier and the team’s leader, refuses.
Myint, a Karen rebel familiar with the area, leads the mercenaries to the site of the massacre. As they survey the damage, a squad of Tint’s soldiers arrive in a truck with a group of prisoners, whom they proceed to torment. Rambo arrives in time and kills the soldiers with his bow and arrow, freeing the prisoners. Rambo joins the mercenaries, and they make their way to Tint’s camp at night, where they stealthily rescue the rest of the surviving prisoners.
The following day, Tint and his soldiers pursue Rambo and the group. Rambo kills some of them by luring them toward a booby-trapped unexploded Tallboy bomb, but the rest of Tint’s forces capture everyone except Rambo, Sarah, and School Boy, the mercenaries’ sniper. Before Tint can execute them, Rambo launches a surprise attack with an M2 Browning-equipped technical, allowing the mercenaries to escape and engage them. The Karen rebels, led by Myint, arrive and join the fight, helping to overwhelm Tint’s soldiers and their arriving naval forces. Defeated, Tint attempts to escape, but Rambo intercepts and kills him with his machete.
In the aftermath, Rambo, inspired by Sarah’s words, returns to the United States to visit his father at his home in Bowie, Arizona.
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