The book is set three hundred years into the future, with the government taking over everything, including surgical operations. One of the government’s methods is to provide every citizen with the “pretty” operation which makes everyone meet the standard of societal beauty.
The people who lived life before the government took over are known as Rusties. Tally, the protagonist, is awaiting the day that she gets her operation because as of know she is simply an “ugly.” She meets Shay, another Ugly, who tells her of a rebel organization who oppose the operations. Shay urges Tally to join the organization, called the Smoke. Shay later runs away, which causes Dr. Cable, the head of Special Circumstances, to question Tally on Shay’s whereabouts. Dr. Cable threatens Tally saying she will never perform the surgery on her unless she tells of Shay’s location.
Tally agrees and sets off to find Shay, holding a tracking device the whole time. When Tally arrives at the Smoke headquarters she sees many Uglies that she has known. They reveal to her that the operation makes individuals brains go numb, so they become “pretty-minded”. Tally accidentally sets off the tracking device and implicates the Smoke. The special division arrive and capture the Smokies.
Tally manages to escape via a hover board. David, another Smokie, has also escaped and the two plot to save the others. They manage to infiltrate special divisions and attempt to reverse the surgical process. The Smokies are all saved but they still need to discover a cure for the operation. Tally volunteers to undergo the ‘pretty’ surgery in order to help find the cure.