well it depends on what you want.
High Availability comes with a cost.
well it's good that more and more vm providers like DO allow you to create your own network. But many still do, so you need some kind of vpn to securly create a network on top.
I think cost do matter. Look at Wassap. They had only one bare metal server in production until they got acquired. The "Cloud" is sometimes deconnected from the reality.