For $2.00 and 13 pages, this pamphlet gives you exactly what it says, a variety of rules to make your D&D 5E game a bit harder in the long term without greatly changing play balance within an individual combat enounter, as well as one or two ways to make the game harder within that individual encounter.

For example, removing a number of spells such as Teleport, or Gate, or even Create Food and Water will change the game at the strategic level, but not the tactical level.

However, ruling that healing someone at zero hit points requires several minutes - even if using magical healing - can greatly alter what goes on within a tactical combat, since the need to keep PCs above the zero hit point threshold becomes vastly more important.

Even if you don't want to "hard mode" your game, the new rules for escaping combats via chases and the permanent injuries and set backs table are both interesting enough to justify picking this up.