Most recipes are available from the start of the game, provided the player has the necessary skill level and ingredients.

Unlike recipes added by the previous add-on Dead Money, most recipes added by Honest Hearts do not require add-on-specific items or perks. The Honest Hearts add-on adds new crafting recipes to the game that make use of the Survival skill. The decisions the player character makes will determine the fate of Zion. As you try to find a way back to the Mojave, the Courier becomes embroiled in a war between tribes and a conflict between a New Canaanite missionary and the mysterious Burned Man. Things go horribly wrong when your caravan is ambushed by a White Legs raiding band. Honest Hearts takes you on an expedition to the unspoiled wilderness of Utah’s Zion National Park. This sparks the beginning of Honest Hearts. The Courier then arrives in the Zion Canyon and meets the Burned Man, Joshua Graham, who is surprised that it is a different Courier than Ulysses that came to him, as he had figured Ulysses would come to murder him. The White Legs then destroyed New Canaan, sending Joshua Graham (also known as 'The Burned Man'), and the New Canaanites to Zion Canyon, where the Dead Horses stand with them against Caesar. With his help, the White Legs found a large supply of weapons.

After the First Battle of Hoover Dam, Caesar sent Ulysses to the Great Salt Lake to rally the White Legs to destroy New Canaan.

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