After The Hillicker Brothers (Three Finger, Saw Tooth and One Eye) escape from the Glensville Sanatorium of the previous film, they, along with the help of serial killer Maynard Odets, start a murderous rampage near the city of Fairlake, Greenbrier County, West Virginia, where they first murder news reporter Kaleen Webber.
Meanwhile, five friends, Billy (Simon Ginty), his girlfriend Cruz (Amy Lennox), Lita (Roxanne McKee), her boyfriend, Gus (Paul Luebke), and Julian (Oliver Hoare), are on their way to Fairlake, West Virginia to celebrate the Mountain Man Music Festival for Halloween. Along the way to the town, they almost run over Maynard, who was standing in the middle of the road, and crash their car into a tree while trying to avoid hitting him. As they get out of the car to check if he is alive, he suddenly tries to cut one of them. Billy, Gus, and Julian attack Maynard out of self-defense. Sheriff Angela Carter (Camilla Arfwedson) and her partner, Deputy Biggs (Kyle Redman Jones), drive by, witness them kicking Maynard, and apprehend the entire group, including Lita and Cruz. While Angela leaves to take them to the police station, she asks Deputy Biggs to stay back with their crashed car until a tow comes. As soon as the Sheriff leaves, the cannibals appear and kill Deputy Biggs.
After being locked up in the police station, Billy confesses to Sheriff Carter that he owns the drugs and convinces her to let the others go. He stays at the police station while they are released. Meanwhile, Sheriff Carter discovers Maynard is a fugitive wanted for murder and makes arrangements to turn him over to the proper authorities the next morning. Maynard promises her she won’t live that long.
Elsewhere, the cannibals use their truck to pull down a phone pole, taking out service to the town. They then proceed to the power plant, where they kill a guard and shut down the town’s electricity. Most of the townspeople are attending the festival in a nearby town. The teens register at a motel. On her way to visit Billy in the holding cell at the police station, Cruz is chased by Three Finger, who kills her. Julian heads to the police station a short time later but doesn’t notice Cruz being eviscerated down a side street; he arrives uneventfully, only to learn Cruz never made it.