The song is a popular gay anthem and was a big commercial success, reaching number 3 in the band's native UK. It was also a number one hit in the Netherlands and Belgium, and hit the top 10 in Australia, Canada, France, Ireland, Italy and Switzerland. The track reached number 48 in the US pop chart and was a number one US dance hit.
The song was released again in December 2013 after featuring in a Christmas advertising campaign for Boots UK. Smalltown boy was also re-recorded by Jimmy Somerville and released as Smalltown Boy Reprise (2014) for the 30th anniversary of its initial release.
The song addresses key issues in 1980s LGBT culture. It addresses family rejection for being homosexual and homophobia in British society. It also deals with loneliness and bullying through societal and familial rejection.
An official music video was shot and released later in 1984. The narrative video features band member Jimmy Somerville as the boy who has experienced the issues described in the lyrics. Seen on a train, he is contemplating his childhood through flashbacks and the events that have caused him to leave his parents' home.
At a swimming pool, his friends (played by band members Larry Steinbachek and Steve Bronski) dare him to approach a young man that he is attracted to, for which he is later attacked in an alley by a homophobic gang led by the man he had approached at the swimming pool. A police officer brings him back to his home. It is implied that the boy's parents learn of his homosexuality for the first time through this incident and are shocked, but only the father seems unsupportive. The boy then catches a train to London, on which he is reunited with his friends.
In 2013, Dutch symphonic metal band Delain covered the song which is featured on their album Interlude.
In 2013, Austrian AOR band Cornerstone covered "Smalltown Boy" as a charity single for the "Room to Breathe" campaign to support cystic fibrosis research at Nottingham City Hospital. Their version reached number 50 in the Austria Top 75 on 20 December 2013.
^Walters, Barry (20 June 2000). "His beat goes on". The Advocate. Here Publishing. p. 115. ISSN0001-8996. As Bronski Beat's falsetto leader, Somerville made gay politics a hot pop topic with such hi-NRG dance floor staples as "Why?" and "Smalltown Boy"