/ AbstractWe present extensive observations of the Type II supernova (SN II) 2023ufx which is likely the most metal-poor SN II observed to-date. It exploded in the outskirts of a low-metallicity ($Z_{\rm host} \sim 0.1~Z_\odot$) dwarf ($M_g = -13.23\pm0.15$~mag; $r_e\sim 1$~kpc) galaxy. The explosion is luminous, peaking at $M_g\approx -18.5~$mag, and shows rapid evolution. The $r$-band (pseudo-bolometric) light curve has a shock-cooling phase lasting 20 (17) days followed by a 19 (23)-day plateau. The entire optically-thick phase lasts only $\approx 55~$days following explosion, indicating that the red supergiant progenitor had a thinned H envelope prior to explosion. The early spectra obtained during the shock-cooling phase show no evidence for narrow emission features and limit the pre-explosion mass-loss rate to $\dot{M} \lesssim 10^{-3}~\rm M_\odot$/yr. The photospheric-phase spectra are devoid of prominent metal absorption features, indicating a progenitor metallicity of $\lesssim 0.1~Z_\odot$. The semi-nebular ($\sim 60-130~$d) spectra reveal weak Fe II, but other metal species typically observed at these phases (Ti II, Sc II, Ba II) are conspicuously absent. The late-phase optical and near-infrared spectra also reveal broad ($\approx 10^4~\rm{km}~\rm s^{-1}$) double-peaked H$α$, P$β$, and P$γ$ emission profiles suggestive of a fast outflow launched during the explosion. Outflows are typically attributed to rapidly-rotating progenitors which also prefer metal-poor environments. This is only the second SN II with $\lesssim 0.1~Z_\odot$ and both exhibit peculiar evolution, suggesting a sizable fraction of metal-poor SNe II have distinct properties compared to nearby metal-enriched SNe II. These observations lay the groundwork for modeling the metal-poor SNe II expected in the early Universe.