The Horror Show at Extreme Rules was the 12th annual Extreme Rules professional wrestling pay-per-view (PPV) and livestreaming event produced by WWE. It was held for wrestlers from the promotion's Raw and SmackDown brand divisions. The event was broadcast on July 19, 2020. While the majority of the event aired live from the WWE Performance Center in Orlando, Florida, the main event was pre-recorded at an undisclosed location about two hours outside of Orlando on July 16–17. The concept of Extreme Rules is that the event features various hardcore-based matches. The 2020 event was the only Extreme Rules event to have an altered title, and as its name implies, the event had horror-themed matches on the card with a basis in hardcore wrestling.

The event was originally scheduled to be held at the SAP Center in San Jose, California; however, the Santa Clara County government restricted public gatherings indefinitely due to the COVID-19 pandemic. As a result, and just like the majority of WWE's other shows since mid-March, the event was moved to the WWE Performance Center in Orlando, Florida. It was subsequently the final WWE pay-per-view for Raw and SmackDown to be held at the Performance Center, as WWE's events for the two brands were moved to Orlando's Amway Center the following month in a bio-secure bubble called the WWE ThunderDome. WWE's developmental brand NXT would permanently move its shows to the Performance Center in October.

Seven matches were contested at the event, including one on the Kickoff pre-show. Four of the main card's matches were contested under a hardcore/horror stipulation. In the opening bout, Cesaro and Shinsuke Nakamura defeated The New Day (Big E and Kofi Kingston) in a tables match to win the SmackDown Tag Team Championship. Meanwhile, Seth Rollins defeated Rey Mysterio in an Eye for an Eye match. In the penultimate match which was also the final match from the Performance Center, Drew McIntyre defeated Dolph Ziggler to retain the WWE Championship in an Extreme Rules match in which the stipulation only applied to Ziggler; McIntyre had to wrestle under regular singles match rules. In the main event, Bray Wyatt, who briefly returned to his cult leader persona for this match, defeated Braun Strowman in a Wyatt Swamp Fight, which was produced as a cinematic match.