The game story follows the male protagonist named by the player who is a high-school student. The story focuses on day-to-day life of a student, thinking about dreams and aspirations for the future until the time of graduation. During your time as a student, you will meet many friends, most of them being girls, and lend them your hand in the time of need. As the title implies, true tears come from worries and troubles that students have to face and thinking of their path in life after graduation.

It is a visual novel for the most part, meaning your constant conversations with other characters and occasional choices which, unlike the typical story branching, are used to help girls in need. Whether you give them advice, lend a moral support or praise them, you can reduce their stress and worry level which is displayed as number of tears. Each week on your calendar you can select up to three days and characters you wish to talk to and help them in your hour of need. You can see how stressed a character is by the number of tears next to their character icon.

True Tears for PlayStation 2 is a port of the Windows game with the same title that was released a couple of years later. The original game did not include adult content, so there was nothing to be stripped for PS2 port. In addition to the game, the PlayStation 2 port also includes bonus Drama CD as well as School Graduation Album booklet featuring game characters and event CG.