Rhythm Tengoku's gameplay focuses on audio cues rather than visual cues to convey information to players. It features a number of unique stages which have their own type of rhythm and gameplay. Players follow the rhythm (in some rhythm games as a character) until the end where they are given a score based on their performance.

The gameplay is fairly simple. The game is divided into sets of four or five music-based mini-games, which are completed by pressing buttons in time with the rhythm. Upon completion of each mini-game, the player's performance is evaluated and given a ranking: Try Again, OK, or Superb. If a player gets a Try Again rating, they can't progress to the next mini-game until they can get one of the higher ratings.