Dr. Shaun Murphy questions the need for an elective surgery that will allow his young patient to smile for the first time. Meanwhile, Dr. Claire Browne and Dr. Morgan Reznick discover that their patient lied about her identity.
Shaun, Dr. Andrews, and Dr. Park meet with Gretchen, a patient who has Moebius Syndrome. She and her father hope an elective surgery will give her the ability to produce facial expressions (the sole limiting factor of her condition), most notably a smile. Shaun questions the importance of the procedure and lists the possible risks, leading to Gretchen claiming he has talked her out of the surgery. After some coaxing, she reveals her true motive for changing her mind: the procedure is very expensive, and not covered by insurance.
Andrews appears at the insurance office in person and persuades them to cover Gretchen's surgery. She agrees to go forward with the surgery, but does not appear to wake up from anesthesia afterwards, leading the doctors to conclude she is brain-dead. However, Park develops a hypothesis she may have an extremely rare deficiency leading to the long wake-up time. Testing reveals he is correct, and when Gretchen awakens, father and daughter are thrilled by the result of her surgery.
In the meantime, Morgan and Claire treat a patient named Lucy, who has a post-op infection. After receiving a prescription, she flees the ER, but Claire soon hears she has returned. It is revealed the woman they treated was not really Lucy, but an imposter who stole her identity. The real Lucy shows up at St. Bonaventure complaining of shingles and asks for pain medicine.
Through research, Morgan discovers Lucy is addicted to pain pills, and her case of "shingles" was a cover. When Lucy claims she lost the pills she was given, Morgan confronts her and talks her into going to rehab.
Later, the imposter returns, having gone into septic shock. Her condition worsens rapidly, and she eventually reveals her true identity to Claire. When the imposter dies, Morgan and Claire ultimately elect not to try and revive her, feeling there is "nothing left to save."
Celez returns to St. Bonaventure to have Jared check her tilapia skin grafts. When the two begin flirting, Jared realizes he has feelings for her. He confesses the problem to Shaun: a rule exists prohibiting doctors from dating their patients. Shaun agrees to take over Celez's care so she and Jared can begin seeing each other.
It is also shown Jared applied to a medical school in Denver, Colorado, and has just been accepted.
That night, Shaun arrives at Kenny's apartment, having been invited for pizza night. Kenny reveals several of his friends showed up unexpectedly, and he borrowed Shaun's TV so they could watch a game. He declines Shaun's request to join in, citing Shaun's "quirks" as uncomfortable, and takes the pizza for himself.
Dr. Glassman becomes close to Debbie, a cashier at St. Bonaventure's cafe. Despite an initially awkward first date, they discover a shared interest in cars. The two go to a restaurant together for their second date, and Glassman tries to ask for the check, but repeatedly asks for a doorstop instead. Panicked, Debbie sends someone to phone an ambulance.
- The title of this episode comes from Gretchen's desire to have a smile. As a result, Shaun begins testing a (somewhat off-putting) smile on others around the hospital.