As you build up a profile, you'll be presented with a slew of different titles -- some stuff you've already seen, some stuff you haven't but obviously won't be into (looking at you, Disney's Invisible Sister), and some stuff you're unsure of. You have the option to swipe upwards to skip; I swiped up whenever I stumbled across something I hadn't heard of, but didn't know enough to dislike it. The algorithm just gets smarter and smarter about what you like, so it might float the skipees back by you at a later time.
When you sign up for the app, you select which streaming services you're subscribed to, and MightyTV only recommends titles from the services you're signed up for. It currently supports Netflix, Amazon Prime, Hulu, HBO GO, HBO NOW, Showtime, and Cinemax. You can also choose to see stuff that's available to rent or buy on iTunes, if you're into that. Add titles to your Watchlist as you swipe through -- it's an easy way to create a queue to revisit, and everything you toss in there factors into the algorithm (along with your likes, dislikes, and loves).