1. Geo-Targeting - no matter what geographic setting you create they will run your ads all over the world unless you know how to change settings they have intentionally hidden.
2. Keyword Selection - No matter how much effort you put into selecting the best keywords they pretty much run your ads on whatever keywords they want. They make it extremely difficult these days to control what keywords trigger your ads to show up.
3. Campaign Caps - A cap is a limit you can set on how much a campaign will spend each day. Except google will spend up to 2x your cap. So you would think you should just set the cap at half of what you really want but they have complicated algorithms in place to screw up your campaign if you do that.