Located in the Capital Wasteland, the former Washington metropolitan area, Megaton is a fortified settlement housing dozens of survivors from a devastating nuclear war, constructed out of scrap metal and other scavenged materials.

This moral choice, which can result in Megaton's permanent annihilation and the deaths of most of its residents, proved controversial and led to the game being censored for Japanese audiences, due to the atomic bombings of Hiroshima and Nagasaki.

Comparing it to the Vaults, hermetically sealed bunkers once used to survive the Fallout universe's apocalyptic war, he described life inside them as a "mildly fascistic and sterile existence", noting that their inhabitants "traded their freedom for security".

Citing the town's inhabitants, including its sheriff Lucas Simms, he says that Megaton "has all the charm of Mayberry, without white picket fences, Little League fields, or trappings of civil society," calling it "downright quaint when considered alongside other end-times groups".

Burford of Kotaku called Megaton "an interesting location, one of plenty in a game loaded with places that have their own personality and flavor," singling out the quest-giver Moira Brown and her "Wasteland Survival Guide" sidequests as "a fantastic way to get an introduction to the world".

Citing the fact that the Japanese ratings board modified the quest so the bomb was permanently defused, the publication called the censorship evidence of the country's "gaping cultural wounds", despite the game having been "voted one of the top ten RPGs ever by readers of Famitsu".