I really like this supplement. I got it via the Haiti Relief promotional and otherwise would have missed this product. One of the issues I have with 4th Edition is the 'Super Hero" quality of the play. WIth so many healing surges, it is fairly common that the party is rarely at risk of losing any members in combat until the third encounter of the day. While this plays well in most of my campaigns, in a horror-styled campaign, one loses some of the tension and edge because one's party is never at risk on the first or second encounter. Rugged Adventures is a tweaking of the rules so that the party recovers slower, and thus is more vulnerable on the second and subsequent encounters before the party's extended rest. (An extended rest possibly requiring two days of rest rather than 6-8 hours; a short rest requiring 6-8 hours rather than 10 minutes, etc). The product goes further by giving ideas of how this adjusted system would deal with daily powers (which are now gained back after two+ days of rest); encounter powers (which would now come back after 6-8 hours of rest); magical items, etc.
If you like the way 4th Edition runs regaining of health, use of surges, encounter, and daily powers, then this product is not for you. If you have a problem - or want to tweak the rules to run closer to 3.0 or 3.5 - or just want to run a more deadly campaign or scenario at any time, then it would behoove you to pick up this product.
As a caveat, tweaking the surge/encounter/daily power usage in 4th Edition is not an easy task. In other words, there are many powers, magical items, and other what-not in 4th Edition that uses the surge/ecounter/daily power calculus that one product could not touch on them all without being a long list of rule addendums for each relevant power, etc. This product does not do that, but it does set the GM in the right direction. That being said, when I give this product a 5 out of 5, it is with the understanding that it is not a long list, but it is a good explaination of the concept, and a good discussion of the highlights.
I liked it a lot.