Dr. Emory Charbonneau, a pediatrician in Atlanta, shares a practice with obstetrician-gynecologist (OB-GYN) Dr. Alice Butler and Dr. Neal James. On a Friday afternoon, she leaves for a solo weekend trip to run a mountain trail in North Carolina's Nantahala National Forest, training for an upcoming charity marathon. She and her husband, Jeff Surrey, an investment advisor, are barely speaking after a bitter argument. The fight ostensibly centered on her training but masks deeper tensions: Jeff's resentment over failing to make partner, Emory's suspicion of an affair, and months of emotional distance. She drives to Drakeland and sets out Saturday morning on the Bear Ridge Trail.
Emory wakes late that afternoon in a rustic log cabin with a severe concussion. A large, unnamed man tells her he spotted her through binoculars lying unconscious on the trail and carried her to his cabin. It has no phone or cell service, and dense fog makes the roads impassable. He repairs her broken sunglasses but refuses to give his name. Emory discovers he removed her phone's battery to prevent global positioning system (GPS) tracking and finds a bloodied rock hidden in the firewood box, stained with her blood and hair. She attacks him with a butcher knife, but he disarms her easily. When she accuses him of holding her prisoner, he replies: "I'm not keeping you in, Doc. I'm keeping them out."
Meanwhile, Jeff spends the weekend with his lover, dismissing Emory's silence. He reports her missing only on Sunday afternoon. Sergeant Detective Sam Knight and his partner, Detective Buddy Grange, take the case, treating Jeff as a suspect given his delayed report. A parallel thread follows Federal Bureau of Investigation (FBI) Special Agent Jack Connell. For four years, he has been hunting a fugitive connected to a mass shooting in Westboro, Virginia. His only lead is the fugitive's sister, Rebecca Watson, whom he tracks to Seattle, but she refuses to reveal her brother's whereabouts.
Events escalate when Norman and Will Floyd, two brothers living nearby, arrive with their 15-year-old sister, Lisa, who needs treatment after a miscarriage. The unnamed man breaks into a rural doctor's office so Emory can gather supplies, and she treats Lisa through the night at the Floyds' house while the man stands guard. Lisa confides that both brothers sexually abused her and that either could have fathered the baby she lost. When Emory's photograph appears on the Floyds' television alongside a reward announcement, the man fires the brothers' shotgun at the screen to prevent them from recognizing her. He and Emory escape, and he slashes the truck's tires to prevent pursuit.
With the roads finally clear, the man tells Emory he will take her down the mountain at dawn. That night, they sleep together, and he whispers to her to "make memories" for him. Before dawn, he drives to the Floyd house and beats both brothers for abusing Lisa and for their connection to an event in Virginia. He tells Norman: "You only thought you missed all the excitement of Virginia." He arranges for Lisa to go to relatives in Drakeland, then drops Emory at a gas station. Deputies, media, and a hospital visit confirming her concussion follow.
Disguised among volunteers outside the hospital, the man notices Jeff's ski jacket is missing its zipper pull. He realizes the silver trinket he found beneath Emory on the trail is the logo charm from Jeff's jacket, implying Jeff was present during the attack. Inside, Emory lies to the detectives, providing only vague details about the man. She privately asks Alice for emergency contraceptive pills, confessing she slept with the stranger, unaware that Alice is Jeff's affair partner. Emory's unease deepens that night when Jeff asks about her repaired sunglasses, since she never told him they broke. Grange confronts Alice in Atlanta; Alice confesses to the affair and claims Jeff was with her all weekend, providing his alibi.
A nanny cam from the burglarized office shows Emory collecting supplies. The detectives identify the cabin's occupant through a fingerprint as Hayes Bannock, a fugitive Connell has pursued for years. Connell arrives and tells Emory that Bannock is connected to a mass shooting that left eight people dead. That night, Hayes appears on the neighboring hotel balcony, shows Emory the zipper pull, and tells her it fell from Jeff's jacket during the attack. He asks: "Are you staying with them? Or coming with me?" She takes his hand, and they flee.
At a safe house, Hayes explains how the zipper pull and the bloodied rock point to Jeff's presence at the scene. Despite knowing Hayes is hunted, Emory stays. Hayes tells her: "You're right. Only seven of them were innocent," implying the shooter was a victim too. The next morning, he drives her to Connell's motel, where the full truth emerges. Connell recruited Hayes for his FBI Special Weapons and Tactics (SWAT) team; they are grudging allies. Hayes was not the Westboro shooter but the unnamed SWAT officer who killed the gunman, a bullied 17-year-old named Eric Johnson, ending the siege with a legendary shot. Hayes vanished because he could not bear being celebrated for killing a teenager. He spent four years punishing those who tormented Eric: an abusive soccer coach, a shaming priest, a mocking hairdresser, and the Floyd brothers.
The investigators convene. Emory learns Alice is Jeff's affair partner and is devastated. They plan to arrest Jeff, but Lisa calls Hayes in a panic: The Floyd brothers have left the hospital and are threatening her. Jeff, who manipulated the brothers into using Lisa as bait, leaves his hotel armed. Alice, arriving at Jeff's suite after he departs, calls Emory to warn her and confesses she lied about Jeff's alibi: He left her house early Saturday morning, giving him time to reach the trail.
Emory races toward the Floyd house to warn Hayes. Connell, Knight, and Grange go to arrest Jeff but find him shot dead, killed by Alice. Emory crashes in fog and continues on foot, only to be struck from behind, the blow depicted in the novel's deliberately misleading Prologue. Alice is the attacker. She confesses that she attacked Emory on the trail the previous Saturday, driving from Atlanta while Jeff slept. She intended to kill Emory and frame Jeff, eliminating her rival and the lover who would never leave his wife. She planted the zipper pull at the scene to implicate him. As Alice aims the pistol at Emory, Hayes emerges from the woods and shoots Alice in the leg. When Alice turns the gun toward Emory, Grange fires the fatal shot.
In the aftermath, Hayes tells Emory that Lisa and Pauline, Lisa's mother, are safe. He kisses Emory, then vanishes as emergency medical technicians (EMTs) take her away. An epilogue set six months later finds Emory crossing the marathon finish line. Norman and Will Floyd have been convicted of statutory rape. Hayes appears behind her: "Good race, Doc." He has been working in disaster relief construction and has reconciled with Connell and his sister. He counseled Grange through the trauma of shooting Alice, asking: "Could you live with yourself if you hadn't?" He promises Emory he will never disappear again.