1) Incredibly, shockingly poor hygiene. Dirty black rags being used repeatedly to dry plates at restaurants. Idlys being cooked on plastic sheets inside hot streamers. Infernoes of uncollected trash burning on streets. Rats and cockroaches everywhere including your toothbrush at night.
2) Utterly horrifying road conditions. Potholes large enough to cause motorcycle crashes every 100 feet. A culture of not giving the other motorist more than 6 inches on any side. Driving on the wrong side of the road, including on highways. It's incredibly stressful to think about your odds when you leave the house.
3) A political system that no-one is optimistic about. Stories are rampant of politicians buying votes by giving free household appliances away to the poor, and then doing nothing in office to help them.
4) An education system that isn't remotely good enough. Miserable professors, antiquated curriculums that churn out the IT coolies we're so famous for.
5) Congestion so bad you hardly ever leave a 5-mile radius. People tend to hang out based on which neighborhood they live in, because a trip to a friend's place more than 5 miles away can turn into an hour-long slog on terrifying roads.
6) A culture of being cheap. If you're only willing to tip your waiter 10 rupees, it may help out your savings rate, but it certainly won't help the waiter buy his kid a computer someday. Same goes for our beloved household servants, who get paid $150 per month at best, $40 at worst to clean our floors.
But to voice a conflict that everyone who lives here talks about, I'm not a pessimist about India by any means, because it's amazing how much the people of this country have achieved through individual hard work in the face of so many poor institutions.