The novel tells the story of three orphans in Laos during the Laotian Civil War and follows the trajectories of their lives after they are separated.

[2] The novel follows multiple characters in a third-person omniscient narrative and is divided into six stories that take place over the course of six decades.

The Royal Lao Government was supported by the United States, which wanted to stop the spread of communism throughout Southeast Asia.

The Central Intelligence Agency's paramilitary operation trained ethnic groups including the Hmong as guerilla fighters against the Pathet Lao.

The bombings totaled more than the amount dropped on both Nazi Germany and the Empire of Japan during World War II.

In 1969 in Laos during the Laotian Civil War, Alisak and brother and sister Prany and Noi are homeless teenage orphans who have been friends since childhood.

The three orphans are spotted sleeping by a river by a nurse who recruits them to work for a hospital overlooking the Plain of Jars.

The three orphans work as orderlies in the hospital and couriers, delivering medical supplies on motorbikes left by the Tobacco Captain.

Touby tells Auntie that Prany and Vang are in a prison in the northeast close to Vietnam, where they share a cell and are tortured by "the interrogator" and two other men.

Prany takes a doctor's coat and puts it on, finding an old piece of paper with a circle written on it.

She searches for Alisak then finds him looking back at her with an expression which Noi views as "the greatest gift, like something wonderful and old, as though, like some unrecognized promise, they had been given a chance, all of them together, to become old."

He thinks of Khit, who came to his shop years ago and gave him a piece of paper she believed belonged to Prany.

As Alisak arrives at the party and looks along the bright seaside towns, he is reminded once again of the hilltop, the sound of animals, the river moving below and the "three children fighting sleep so that they can catch the last moments of a small pocket of fire."

"[17] Publishers Weekly called the novel "a finely wrought tale about courage and endurance" and praised Yoon's "eloquent, sensitive character study of Alisak.

"[11] In his review for The New York Times, writer Tash Aw called the novel an "intense meditation on the devastating nature of war and displacement.

[18] In the acknowledgements section of Run Me to Earth, Paul Yoon lists the works he referenced and incorporated into the novel:[8]