In Turbo Outrun the player controls a male driver sitting alongside his girlfriend in a Ferrari F40, racing against the clock and a computer-controlled opponent in a blue Porsche 959 in a race across the United States. The goal is to reach Los Angeles from the starting point of New York City. Unlike the original Out Run, there are no branch roads to choose from. Instead, there is only one path that can be taken to reach the goal.

A notable feature of the game is that the player can increase speed by using turbo boost by pressing a button on the side of the console-mounted shifter; the engine temperature will increase in kind on the on-screen gauge. When the gauge reaches "OVERHEAT!" turbo boost cannot be used until the temperature decreases.

Another difference is that police cars occasionally appear that try to stop the player. They have to either be outrun by using the turbo boost or destroyed by the player by ramming them off-road and into an object on the side of the road.

Unlike the original Out Run, Turbo Out Run offers the player a choice between automatic transmission or two-speed manual transmission.