Following the events of Hostel, Paxton suffers from PTSD and lives in seclusion with his girlfriend Stephanie. After an argument where Stephanie denounces Paxton's paranoia as exaggerated and insufferable, she wakes to find his headless corpse in their kitchen. An unmarked box containing Paxton's severed head is delivered to Elite Hunting boss Sasha.

In Rome, Italy, three American art students, Beth, Whitney, and Lorna, are convinced by Axelle, a nude model they are sketching, to join her on a luxurious spa vacation in Slovakia. The four check into a hostel, where the desk clerk surreptitiously uploads their passport photos to an auction website. American businessman Todd and his best friend Stuart win the bids on Whitney and Beth. They then travel to Slovakia.

Later that night, at the village's harvest festival, Lorna discovers Beth has inherited a vast fortune from her mother. Stuart and Todd attend the festival; Todd remarks that Beth "looks like her", and then Stuart approaches Beth and the two share a friendly conversation. Meanwhile, Lorna is invited by Roman, a local man, on a boat ride. In a secluded area downstream, Roman kidnaps Lorna. Axelle volunteers to wait for Lorna, and Beth and Whitney leave the festival.

Lorna wakes up naked and hung upside down above a bathtub. A woman enters the room and slashes at her with a scythe to collect her blood in the bathtub. She then bathes in the blood before slashing Lorna's throat. Meanwhile, Beth, Whitney, Axelle, and a local man, Miroslav, head to a spa to relax. Beth dozes off, and wakes up alone without her belongings. While looking for her friends, she is pursued by several men and flees the spa. In the woods, she is ambushed by a gang of violent gypsy street children, but is saved by Sasha and Axelle; Sasha executes one of the boys as punishment.

Later at Sasha's remote mansion, Beth is confronted by the earlier men, and realizes that the men are associated with Sasha and Axelle. Looking for a hiding place, she discovers a room filled with human trophy heads (one of which is Paxton's). Beth is captured and taken to an abandoned factory and tied up in a room.

Beth is soon joined by Stuart, who is supposed to kill her; it turns out Todd, who is wealthy while Stuart is not, paid for Beth for Stuart. Stuart appears to have second thoughts, unties Beth, explains the situation, and says he is "not that guy." Beth goes to the door to try to leave, but someone knocks her out.

In another room, Todd terrorizes Whitney with a power saw, but loses his nerve after accidentally scalping her without killing her. Horrified, Todd tries to leave, but is informed that he has to kill Whitney to leave. After Todd refuses, the guards unleash several dogs, which maul him to death.

Meanwhile, Stuart, who was the one who knocked out Beth, has completely changed his mind and persona, and is now intent on torturing and killing Beth. He reveals that Beth bears an extremely close resemblance to Stuart's wife, whom Stuart hates but cannot kill because it is against the law and he would be the prime suspect. Stuart then begins to berate Beth.

With Todd now dead, the Elite Hunting Club offer the maimed Whitney to the other clients to kill, including an Italian man who is eating Miroslav alive. Stuart, after discovering Todd's death, shows Beth the pictures of the maimed Whitney to frighten her, then accepts the club's offer, leaves Beth and beheads Whitney.

When Stuart returns, Beth seduces him into untying her from the chair. Stuart attempts to rape her, but she fights him off and chains him to the chair. Sasha and the guards arrive at her cell. Beth offers to buy her freedom with part of her inheritance, and though Stuart tries to outbid her, Sasha reveals that he knows that Stuart cannot afford to do so. Sasha tells her in order to leave, she must also kill someone. When Stuart insults Beth, she cuts off his genitals, leaving him to bleed to death. Satisfied, Sasha gives Beth an Elite Hunting tattoo, making her an official member.

That night, Axelle is lured by the Gypsy street children into the woods, where Beth ambushes and beheads her. Shortly after, the children start playing football with Axelle's severed head.

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