Margaret Atwood is terrifyingly good at writing believable dystopian stories. She calls this "speculative fiction" rather than science fiction. There is always a fairly clear path between the world of today and the one she presents. "The Heart Goes Last" is no exception.
The book takes place in the not-to-distant future and the collapse of the middle class, especially on the east coast and the mid-west is complete. With little to no tax base municipalities lack the ability to provide basic services and crime is rampant. The story follows a couple struggling to survive in this world who are offered the opportunity to join a new walled town where they will be guaranteed a job and a home and everything they need. The only catch is that they, like everyone else in the town, spend every other month in prison. The care and maintenance of the prison and its prisoners drives the economy of the town allowing it to be self-sustaining. Of course there are darker motives behind the people running the experimental town and the main characters are quickly swept up into the intrigue.
The book was a fun, quick read and I can't criticize it too much. However I wish Atwood had spent more time exploring the broken world outside the town and less on the corporate greed and corruption behind it. She can be truly terrifying when depicting humanity's possible future and although the beginning of the book has that quality it quickly devolves into more of an adventure story. That isn't a bad thing, I just wanted more.