a realistic game in a fantasy setting? no thank you

you would just take a lot of spice out of the gameplay - if you want a realistic fallout game - look into the division (and how boring it looks)

Stalker pretty much represents the closest we can get to a post-apocalypse survivor sim. And even then one of the reasons why its realistic and fun is because the rest of the world is still 100% functioning beyond the wild lands of The Zone, ensuring a heavy supply of arms and equipment for lots of action funtimes.

If someone wants a highly realistic, tough and unfair, and basically showcasing just how useless you'd be after the fall of society survivor sim I would recommend the MISERY mod for Call of Pripyat. I can't think of a game beyond those Kazio-level mods/romhacks that comes close to providing such a harsh and unforgiving difficulty.

if it was realistic there would be nothing left, at least in the lower 48.

I was in Strategic Air Command. I saw the charts for what the effects of a full scale nuclear exchange between the US and Soviet Union with the arsenals we had circa late 1980s. It would be much, much worse than you imagine.

Putin's waving his dike around and Obama just blew 3 trillion on a new nuclear arsenal we might just get that apocalypse yet. Fingers crossed.

I don't mind the game is unrealistic, it would be unplayable as written if it wasn't.

If I want realism, I'll play Forza Motorsport (car sim).

Are you kidding me? More realistic? Haha. It is a video game by one of the best gaming companies ever. If playing survival mode isn't hard enough for you and you want to be more realistic then go on a camping trip through some third world country dude. The game is fine the way it is.

Hmmm, I want to start a realistic role-play now!

So apart from the one shot one kill, if we were to play realistic, well as close as we could get. What would we strip away?

My guess is:

Stimpacks.

Radaways (unless you go to a doctor maybe?)

Mods for guns

Mods for clothing/armour.

I dont think I could strip away the perks, maybe could go along the lines of say, what you learn from the wasteland, who you talk to, what you see and pick perks accordingly. Like Lone wonderer, lockpickin etc, None of the damage or resistance perks etc. But 'realistic' perks.

I think that could be quite fun.

The Perk System itself is already unrealistic. Increasing Weapon Damage? Better Accuracy? It should be more like so more you shoot with a kind of Weapon so more you learn how to handle and not just you earn 20% more Rifle Damage its just CoD. Stimpack Healing increased? So long you didnt learn anything abotu to make them Better, ofcourse not. Damage Resistent Perk or Lone Wanderer Perk the most Things are more or less Magic Enchantments. As Example GTA San Andreas you got Stamina from running Boxing other People. I would like to see a System earning Skills by actually doing those Things and not that easy System we got in TES or Fallout. In Skyrim it was a kind of it. Using more and more Skills and you got sooner the Access to new ones, but still to CoD. The whole System is made for Babies, for the 3 Button Generation

That is not all that much fun I find. I much prefer the brutal Narodnaya Solyanka myself, it's the hardest one of the lot. Where there were Dogs are now Chimeras in some places. It will test you. Misey is a little too miserable for me.

The Fallout world is too well-conserved for a two centuries abandoned place. I would say that is more like 70 or 80 years than 210.

There would be no power, and basically all buildings/houses would be completely destroyed by the time. Also everything that's metal would be only small pieces of rust, if there was something left.

Also, no Nuka-Colas. 200 years cola? No, thanks.

The local flora would dominated everyplace. More to a forest than a abandoned city.

Most metals don't oxidize away to nothing. Your statement assumes that ALL metal is pure iron.