[3] A Blackfeet man named Ricky leaves a bar and finds an elk stumbling into several cars in the parking lot, damaging them.

Ricky is caught outside with the damaged cars by the white bar-goers, and chased by them into a field, where he sees the reflections of the eyes of a herd of elk.

Lewis, one of Ricky's childhood friends, has likewise moved off their reservation and married a white woman named Peta.

One night, while fixing an overhead fan light, Lewis sees the image of a dead elk on the floor below and almost falls to his death, saved by Peta at the last moment.

When Peta returns home, Lewis startles her while she is working on the ceiling fan light, causing her to fall and fatally hit her head.

He returns to the sweat lodge with an old thermos he finds for a water scoop, which Cass recognizes as the hiding place where he keeps his money and an engagement ring he bought for his girlfriend Jo.

Eventually the elk spirit is unable to hide her nature anymore due to her injuries, and transforms into an elk-headed figure with the body of a woman, beginning a long pursuit of Denorah through the snowy reservation.

Carlos Tkacz asserts that this novel is a form of ecohorror: a genre of horror that contends with and responds to fears about Earth’s climate and environment.

He writes that the novel deals with fears of environmental destruction and that Jones combines awareness of modern ecological issues with the history of violence against indigenous peoples.

[8] In this novel, the elk also occupies a similar role to the mythical figure of the Deer Woman that is present in many Indigenous cultures, who commonly acts as a symbol of fertility or a creature that leads men to their death by seducing them.

[9][10] Jones stated that the idea for The Only Good Indians likely began to develop while he and his wife were renting a home in Gunbarrel, Colorado.

Having participated in elk hunts on reservation lands since the age of 12, Jones drew from his personal experience to illustrate such an accurate and haunting situation.

[18][19] The novel received reviews from outlets such as The Washington Post and Los Angeles Times, the latter of which wrote that the novel "strains to weave a horror story with robust character studies.

"[20][21] NPR praised Jones as "one of the best writers working today regardless of genre" and stating that "Besides the creeping horror and gory poetry, The Only Good Indians does a lot in terms of illuminating Native American life from the inside, offering insights into how old traditions and modern living collide in contemporary life.