Those squeamish about seeing disease — in all its gauntness, the cough and rattle, the bleary, graying eyes — may have a hard time watching director Jean-Marc Vallée's new film Dallas Buyers Club. Which isn't to say you shouldn't see the film. In fact, it's an encouragement to see it, as it's blessedly free of the useless gauze and gloss of so many death and dying weepies before it. The film is a sober, unflinching look at a man (well, many men), coping with AIDS in the 1980s, though not in New York or San Francisco as we've come to expect from movies about this disease. As the title would suggest, we're instead in Texas, dwelling in shabby corners of Dallas. It's an unexpected place to find a story like this, though the film is based on a scrappily uplifting true one.

Matthew McConaughey, whippet-thin and slightly hunched, plays Ron Woodroof, a good ol' boy who likes weed, whiskey, and women. We first meet him as he's having sex with an anonymous woman at a rodeo, before running out on a gambling debt, chased by a group of angry cowboys and rescued only after he punches his cop friend, forcing an arrest. Ron works as an electrician, but we get the distinct sense that he's not long for that world, that he's a ne'er-do-well on a downward trajectory. That hunch is confirmed, in even grimmer fashion than imagined, when Ron collapses in his trailer home and wakes up in the hospital only to be told that he has AIDS, and may have as little as 30 days to live. Wracked with pneumonia, Ron is a hacking mess, but he refuses to acknowledge what his doctors have told him. AIDS is for gay people, and Ron Woodroof is certainly no homo.

It's only when he's ostracized from his community — meaning his job and his regular bar — after drunkenly divulging his diagnosis to a friend that Ron begins to realize both how alone he is and the true severity of his condition. So he returns to the hospital looking to get into an AZT trial he's heard about, only to be told that the waiting list is long and, anyway, some patients are being given placebos. Suddenly possessed with a tenacious will to live, Ron taps into his wily smarts and sets about procuring the medicine himself. First with the help of an orderly, and then through far more elaborate means.

Thus begins the hum and process of Dallas Buyers Club, which walks us through the bureaucratic nightmare of big-pharma with the right amount of righteous anger and weary dismay. The AZT is so toxic that it's making Ron, and other people on the drug, even sicker. Ron does his homework and learns that there are other treatments that have proven effective, only they're not approved by the FDA, so of course they're not available in the United States. Clever Ron finds a way around that, and soon he's importing drugs from far-flung countries and running a buyers club out of a cheap motel, with the unlikeliest of partners. Bigoted in the way one would expect a Texan rowdy in 1986 to be, Ron is wary of the gay men he's forced to associate with to run his business, but he nevertheless finds his closest ally in Rayon, a willowy, honey-voiced trans woman played with warmth and grace by Jared Leto. Ron and Rayon have a bickering, eyes-rolling chemistry, and it serves them well as they do the important work that the medical institutions won't.

So in some ways Dallas Buyers Club is a movie about tolerance, about Ron's journey toward social enlightenment, about what an open mind grants one access to. And in that vein it's a lovely, lively character study. It's also a film about little guys triumphing, however briefly, over big and maddening systems, a grassroots tale about a discounted man accessing previously unknown reserves of pluck and intelligence to at first serve himself and his financial concerns but then, over time, coming to see the higher purpose, the bigger need. In its quiet, low-key way, the movie is feel-good and heartwarming. Vallée has made a delicate, but largely unsentimental, movie about people doing good deeds. His restraint should be studied by other filmmakers working in the genre, lest we get another Patch Adams someday.

That nice stuff aside, the film is also, as mentioned above, one about illness. About despair and fear. We are never too far from the knowledge that Ron and many of those around him are indeed dying. And while that may seem grim, it's also somberly respectful of the true horror of those plague times. McConaughey famously lost a lot of weight to play the role, and while that certainly puts a visual stamp on his commitment to the performance, there's an internal depth and conviction that is the true transformation here. The beady-eyed desperation roiling underneath Ron's twangy country boy veneer is always felt, the jittery, surreal dread of staying one step ahead of death. In McConaughey's hands we like Ron and are scared for him, but he doesn't try to win us over. There's a simple humanity to the performance, one truly dignified in its uncomplicated honesty.

Leto has probably the showier role here, swanning around in little dresses and vertiginous heels, speaking with the pitched bitchiness of a grand old queen. But he never oversells the role or puts it at a distance. Throughout the film, we are simply watching Rayon, not Jordan Catalano or the weird-haired singer from 30 Seconds to Mars trying out a bit. Like McConaughey, Leto lends humility and forthrightness to the film, existing thoroughly in its world with no Big Moment awards telegraphing or showboating of any kind. That said, a performance as sensitive and sprightly as his probably will earn him some awards down the line.

Appearing as Ron's concerned doctor and vague love interest (though, really, the film avoids anything as easy as that), Jennifer Garner dampens her dewy perkiness, the sort of whispering earnestness, that has sunk her in previous efforts. In tune with Vallée's carefully toned film, Garner graciously gets out of the story's way, playing her moments with an appealing simplicity. The everyday quality of the acting and the direction — there are a few arty flourishes here and there, but mostly as bookends — both makes the happier parts of Dallas Buyers Club that much homier, and of course the tragedies more bruising. Whether this is a sad film about happy things or a happy film about sad things is up to you to decide, I suppose. Vallée and company have simply given us a slice of life and asked us, much like Ron did, to make of it what we will.