Runaway Train begins with a fade to a black screen with big, white blocked text reading: "There are over one million youth lost on the streets of America". The video shows the band playing the song, and Dave singing, while the video cut back and forth to scenes of a man abusing his wife, who later in the video searches for young girls in his car. During the choruses, pictures of missing children would appear on the screen. After each picture was shown, their full name would appear in large capital letters on the screen, along with the year they had been "missing since...".
The video continues with scenes of a lady in a car stalking a younger mother and her baby, in a stroller, and near the end of the video as the mother stops to look at some clothes, the lady kidnaps the baby. After the lady takes off in the car and the mother runs down the street after her, a baby is shown as missing ends the video.
Several versions of the video were made. There were three original versions of the video in the United States, totaling 36 missing children shown. Depending on what country the video was being broadcast, they would show children from that area who are missing. The video was very successful in reuniting many of the missing children with their families. Some of the children even saw themselves in the video and returned home.