The game is inspired by the book of the same name by Ken Follett. The book shares the Kingsbridge location of his earlier novel, The Pillars of the Earth, but occurs 200 years later.
As citizens of Kingsbridge, players need to take care of the following areas: Building, Trading, Religion, Feeding, and Medical Knowledge. Each turn an event card is flipped that defines available player actions. Victory points can be won in numerous ways, e.g. by creating buildings or taking care of sick people.