In an impromptu main event, Brock Lesnar cashed in his Money in the Bank contract on Seth Rollins to win Raw's Universal Championship for a record third time, right after Rollins and Raw Women's Champion Becky Lynch retained their respective titles against Baron Corbin and Lacey Evans in a Last Chance Winners Take All Extreme Rules mixed tag team match.

In other prominent matches, Kofi Kingston retained SmackDown's WWE Championship against Samoa Joe, AJ Styles defeated Ricochet to win Raw's United States Championship for a third time, The New Day's Big E and Xavier Woods defeated Heavy Machinery (Otis and Tucker) and defending champions Daniel Bryan and Rowan to win the SmackDown Tag Team Championship for a record-tying fourth time, and in the opening bout, The Undertaker and Roman Reigns defeated Shane McMahon and Drew McIntyre in a No Holds Barred tag team match, which proved to be The Undertaker's final match in front of a live audience in the United States before his retirement in 2020.

[2] The defunct Extreme Championship Wrestling (ECW) promotion, which WWE acquired in 2003, originally used the "extreme rules" term to describe the regulations for all of its matches; WWE adopted the term and has since used it in place of "hardcore match" or "hardcore rules".

[10] The following night on Raw, Corbin and Evans brawled with Rollins and Lynch and challenged them to a mixed tag team match.

[12] After Ricochet won the United States Championship at Stomping Grounds, Luke Gallows, Karl Anderson, and AJ Styles interrupted a photoshoot, congratulating the new champion.

After the match, Gallows and Anderson attempted to enter the ring and taunted Styles, who held them off, only to attack Ricochet himself, turning heel.

Gallows and Anderson also joined in on the attack, reuniting The Club,[13] and another title match between Ricochet and Styles was scheduled for Extreme Rules.

[11] A falls count anywhere match on the July 1 episode ended in a no contest after Strowman tackled Lashley through the LED video wall of the entrance and both were taken to a local medical facility.

[17] After more feuding on subsequent episodes, The Revival were scheduled to defend the championship against The Usos at Extreme Rules.

[14] At Super ShowDown, Shane McMahon defeated Roman Reigns thanks to interference from Drew McIntyre.

[20] At Stomping Grounds, Bayley retained the SmackDown Women's Championship against Raw's Alexa Bliss.

[11] On the following SmackDown, wild card guest Cross defeated Bayley, thus earning Bliss a rematch for the title at Extreme Rules.

[14] At Stomping Grounds, Daniel Bryan and Rowan retained the SmackDown Tag Team Championship against Heavy Machinery (Otis and Tucker).

[18] Since being drafted to SmackDown during the 2019 WWE Superstar Shake-up in April, Aleister Black began appearing in ominous backstage promos in a dark room, awaiting a challenger.

[10] On the following episode of 205 Live, Nese defeated Tozawa to earn a rematch against Gulak on the Extreme Rules Kickoff pre-show.

[23] On the July 9 episode of SmackDown, Dolph Ziggler took exception to referring to Kevin Owens as his partner the previous week.

[24] In the second and final pre-show match, Drew Gulak defended 205 Live's WWE Cruiserweight Championship against Tony Nese.

[24] The actual pay-per-view opened with The Undertaker and Roman Reigns facing Shane McMahon and Drew McIntyre in a No Holds Barred tag team match.

Shane then went to the top rope and performed a diving elbow drop on Undertaker through the English announce table.

As Rollins and Lynch were setting up tables outside the ring, Corbin and Evans attacked them and performed simultaneous chokeslams for a nearfall.

Back in the ring, Rollins attempted The Stomp, but Corbin countered into a powerbomb and followed up with a Deep Six, but Lynch broke up the pin.

An irate Rollins then furiously attacked Corbin with a kendo stick and a steel chair, followed by three Stomps to retain both his and Lynch's respective titles.

[25] The following night on Raw, a cross-branded all-star top 10 battle royal was contested to determine the number one contender for the Universal Championship.

Seth Rollins won the match by last eliminating Randy Orton to face Brock Lesnar in a rematch for the title at SummerSlam.

[28] Subsequently, Rollins was on the receiving end of brutal attacks from Lesnar on both the July 29 and August 5 episodes, which resulted in a storyline rib injury.

[29][30] Following Extreme Rules, The Club (AJ Styles, Luke Gallows, and Karl Anderson) were renamed to "The O.C."

(Original Club), and Ricochet won a five-man gauntlet match on the July 29 episode of Raw to earn a rematch against Styles for the United States Championship at SummerSlam.