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So, would you recommend that newer startups just stick with a good old-fashioned full-stack monolith deployed on any old VPS?

Yes absolutely. I've been very impressed that Rails has managed to stay relevant all these years later.

I hope the NodeJS world can turnout something as turnkey and well-supported as Rails, but I haven't really seen it yet.

The choice of stack really just depends on the project, and the skillsets of developers in that community + the available tools in that community.

Yo clearly missed all of the Next is now PHP/Rails and Next.js as PHP and Rails logo [1] memes :)