The correct high-availability solution should take business requirements into account and there is no silver bullet. Running everything on a $5 VPS is no silver bullet, but neither is your typical "cloud-native" "best practice" stack that everyone keeps cargo-culting which often leads to unnecessary cost while leaving many hard questions (such as replicating CAP-bound stateful databases) unanswered.
If we're talking about reliability/outage recovery, we're considering the application as one single unit visible from the external client's perspective - so everything including the DB (or equivalent stateful component) must be redundant.
Sadly this is also where a lot of cloud-native tooling and best practices fall short. There are endless ways to run stateless workloads redundantly, but stateful/CAP-bound workloads seem to be ignored/handwaved away.
I've seen my fair share of stacks that are doing the right thing when it comes to the easy/stateless parts (redundancy, infinite horizontal scalability), but everyone kinda ignores the elephant in the room which is the CAP-bound primary datastore that everything else depends on, which isn't horizontally scalable and its failover/replication behavior is ignored/misunderstood and untested, and they only get away with it because modern HW is reliable enough that its outage/failover windows are rare enough that the temporary misunderstood/unexpected/undefined behavior during those flies under the radar.
And so no, most teams don’t need to worry about the hard problems you bring up.
And spinning up a new VM typically takes longer than a minute. Even on cloud providers.
Our environments are easily repeatable, they're very maintainable, but they're not quick to start up