I couldn't play without mods. We've got a camera distance adjuster, all the stuff I made to help redo / recolor character creation elements, and a mod to spit out a bark when you make shaped / insulated wood. Oh and pippi, which is a really nice server admin thing we barely use much of, but seems really powerful.
Also, for our server settings, we did Durability multiplier 0.2 which is probably a bit much, but there were patches where shields would break after 3 blocks. Spoil rate 0.3, resource respawn 0.5 which is probably a mistake (I think you'd want that at 1 or 2), active hunger thirst 0.3, harvest 2.5.
We also don't drop items which I'm not a big fan of. Sometimes you are really overloaded and thinking... it would be way faster to die to get back to base.
Another friend's server was pvp back in the early days and we had a lot of trouble with accidentally hitting friends when out fighting stuff. It was just us on the server so pvp seemed kind of pointless.
We also have building damage off, which makes the purge less fun. So far the purge seems to only want to attack a random staircase someone made to get up a small cliff though.
BTW did they change how building keeps things from respawning near the building? We had a lot of trouble with that over time, and we adjusted settings to try to fix it, but it was really annoying. Like someone would make a little stairway and the nearby ore would never respawn again.
It isn't doing that at all anymore that I can see. I'm not sure if one of our settings finally fixed it or if they just turned that stupid feature off.