Recent years have witnessed a growing interest in the development of small-footprint lasers for potential applications in small-volume sensing and on-chip optical communications. Surface plasmons-electromagnetic modes evanescently confined to metal-dielectric interfaces-offer an effective route to achieving lasing at nanometer-scale dimensions when resonantly amplified in contact with a gain medium. We achieve narrow-linewidth visible-frequency lasing at room temperature by leveraging surface plasmons propagating in an open Fabry-Perot cavity formed by a flat metal surface coated with a subwavelength-thick layer of optically pumped gain medium and orthogonally bound by a pair of flat metal sidewalls. We show how the lasing threshold and linewidth can be lowered by incorporating a low-profile tapered grating on the cavity floor to couple the excitation beam into a pump surface plasmon polariton providing a strong modal overlap with the gain medium. Low-perturbation transmission-configuration sampling of the lasing plasmon mode is achieved via an evanescently coupled recessed nanoslit, opening the way to high-figure of merit refractive index sensing of analytes interacting with the open metallic trench.