In La Cosa Nostra, you take on the rold of a mafia boss. In the beginning, you control a crew of gangsters and a couple of businesses. During the game, you will hire new gangsters to do the dirty work and collect your money. Investments lead to new lines of business or monopoly positions. To get the big deals, you need to cooperate with the other families, but never rely on those friendships. The others will take the first opportunity to stab you in the back, so you better do it first...

Each player controls gangster cards that serve to either gain money or attack other players. Actions are planned secretly, then played in turn order. Business cards are needed to succeed. Players bargain, spy, threaten, and deceive each other.

Each of the four rounds brings new action cards and gangsters into the game. The possibilities become more diverse, the jobs more profitable, and the attacks more powerful.