When the Doctor, Amy and Rory land by accident in the town of Mercy in 1870, they discover a cyborg hunting an alien doctor: another alien doctor. It has the entire town besieged and waits for the other doctor to come out.
The last time the Doctor visited the Old West was in 1966's THE GUNFIGHTERS. That was a straight historical about the Gunfight at the OK Corral. Since then straight historicals, in which the Doctor and companions visit Earth's past and don't fight a lurking alien menace, have been scarce. Still, it is an excuse for Matt Smith to put on a Stetson.
The story is told in a fairly straightforward fashion, typical of westerns, at a slow, foreboding pace -- which gives the viewer time to ask all the right questions and come up with answers about what is really going on before the plot has a chance to twist. It's a little slow for my taste.
The pleasures in this episode, if you choose to look for them, are about the production values: the mobile camera that settles into occasional odd point-of-view shots; the careful costuming and understated performances that force you to pay attention far better than shouting; and even Murray Gold's score. I have not been a great fan of Mr. Gold's work, but he has been showing a bit of range this season. This time he steals a bit from Morricone and marries it with fiddlework for an appropriate score -- although he does pull up his favored chorale work too readily.
This is Toby Whithouse's fourth script for Doctor Who -- mostly he has been busy with his own series, BEING HUMAN. His rhythms of storytelling here are not the typical rhythms of Doctor Who. It seems as if he is trying to operate within the framework of westerns, where little is said and much is already known. Even the plots are limited in number. In sf, particularly Doctor Who, there is a constant stream of exposition. It's an interesting experiment in mixing the two sets of tropes that doesn't quite work. I'm glad they tried it, though.