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Games that force you to make hard choices
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Fallout: New Vegas. Hell, Fallout 2. In 2 early on, you only have time to one of two quests and people die when you can't help them. You can't save everyone.
Very different from later games where time doesn't matter and the whole world waits for you.
FO3 as well - Megaton specifically lives or dies by your decision.
That and Tenpenny Tower are the only instances that stand out in fo3 though.