I know this is kind-of stupid, but I like playing a rural mapgen run with city size = 0. I even startscum until I am in an area where there are no cabins etc immediately visible. I prefer playing a lost submissive here to make it even harder. I enabled that no fungus mod since it is just overpowered currently in my opinion.
Edit: Discourse is not letting me put the links in here since it considers me to be too new, ugh. You need to remove the spaces from the URLs.
TL;DR: It is hard, quite minimalistic almost and I found a few shortcomings.
Anyways, I found out a few things and opened a few issues.
It very much depends on the mood of the RNG since an early zombear or mi-go or something will wreck the character. Even an odd aggressive bee or wasp could mean the end.
I usually start on day 61 or something and, yes the whole IRC channel made fun of me for that, the cold nights caused my characters arms to freeze off. So it is very important to get a blanket or some arm warmers early, but finding random corpses with clothes is not easy unfortunately. Healing that with no first aid skill was tough. It meant making a lot of bandages, deliberately falling in pits and applying these bandages until I can make splints.
Blankets are easy enough to make but pillows are not. There is no way to get cotton out in the wilderness and hunting birds is also hard early on. I suggested adding straw pillows: Feature request: Straw (and similar) pillows · Issue #49031 · CleverRaven/Cataclysm-DDA · GitHub
An important goal is making a hut for yourself, I usually go with wattle-and-daub walls. Ensuring you will not starve is also very important, this means you need to make some fields. I had the problems of wildlife trampling my fields and suggested adding simple wattle fences (Feature request: Wattle fences · Issue #49138 · CleverRaven/Cataclysm-DDA · GitHub) to solve just that. Someone added that feature pretty quickly. Hooray! \o/
However, there are other difficulties which need to be taken care of. Fortifications are very important, which are mainly just pits. There are currently 2 types of pit trap, the spiked pit and glass pit. Those break pretty quickly and I suggested ideas for more traps: https ://github.com/CleverRaven/Cataclysm-DDA/issues/49008
My main focus are the rebar and sharp stone pits since they should last longer and are easy to make. The others are “just” ideas.
I also found https ://en.wikipedia.org/wiki/Cheval_de_frise, which may be a fitting fortification.
There was also a discussion about adding moats. The only method to somehow get water into your base is digging water channels, which are shallow and can not be made deep.
There are no fluid mechanics and all sources of water are infinite, which may need to get solved first.
In the long run it is important to become self-sustaining. I thought about maybe planting an orchard, but this is not possible yet unfortunately. Maybe one can harvest triffids for some of their instant tree growth thing? https ://github.com/CleverRaven/Cataclysm-DDA/issues/49337
However, there is a little problem now in 0.F - there is no tool with cutting 1 except a bone shiv. Bones may be hard to find though. This triggered a discussion in the IRC channel since I suggested either making the stone knife easier to craft again or using a sharp stone, like the flaking rock or flint as a very basic cutting tool. Kevin Granade chimed in and said there are changes which should be made first in order for this to be possible, most notably durability of tools since a sharp rock will not stay sharp forever.
This is the biggest problem right now, but there have been many changes which made it actually easier, such as large rocks being anvils, more plants and you can also find minerals when mining underground which is pretty nice.
In the end there are still random NPCs which can help one to get going and also some rare roads where you can get vehicles and parts from.