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Mafia: The Old Country is a third-person action-adventure game set in the underworld of 1900s Sicily. Players assume the role of Enzo Favara, navigating the brutal world of organized crime as he seeks to earn his place in the Torrisi crime family. The narrative focuses on Enzo's struggle for a better life after a harsh childhood, highlighting themes of family, loyalty, sacrifice, and ambition within the Mafia.

The game is characterized by cinematic storytelling, detailed visuals, and a focus on authentic historical realism. Gameplay includes combat with period-appropriate weapons such as stiletto blades and lupara shotguns, as well as exploration and missions involving protection rackets, vendettas, and travel by foot, horseback, or early motorcars. Mafia: The Old Country features a Photo Mode for capturing in-game moments, and a Free Ride mode, which was released as a free update, offering additional opportunities for exploration and collectibles. An expansion titled "Man of Honor" is scheduled to add two new chapters and exclusive content for Free Ride mode.

Mafia: The Old Country is available on PlayStation 5, Xbox Series X|S, and PC via Steam. Players can sign up for a free 2K Account to receive in-game items such as the "Garzia Tumulto" race car and additional rewards tied to other games in the Mafia series. Additional items, like the engraved "Lupara Tradituri" shotgun and the "Racketeer" outfit, can be obtained by subscribing to newsletters and promotional messages related to the Mafia franchise.

The game is published by 2K Games and developed by Hangar 13, and is part of the larger Mafia franchise, which includes other titles set in different eras of American organized crime.