The 5e 2024 setting-agnostic approach that relies on each setting to nuance the rules, is the promised "modular" game design. Settings can come with setting-specific mechanics: special rules for leveling, new subclasses, new uses for bastion, etcetera. So far, official settings incorporate most of the Player Handbook options. But indy settings can go much farther to curate and tweak options.
For a medievalesque, low-tech, low-magic setting, there are three easy methods.
1. Curate the classes and subclasses. For low-magic, there are no full casters. Mages are part casters (Paladin, Ranger, Artificer), noncasters (Monk, Barbarian), or martial subclasses (Psiwar, Eldritch, Trickster). The setting context flavors these options. Example, the Tolkien "wizard" Gandolf is mechanically a high level Paladin, who does wield magic and is therefore a "mage".
2. Slow down the level advancement. Levels 5 thru 12 require about fifteen encounters to reach the next level. Require even more encounters to advance. Also focus on nonlevel rewards, such as tricking out a bastion. Avoid accumulating magic items because they can become as disruptive as high-level mages.
3. Most importantly, decide which leveling tiers exist in the setting. Each tier represents a different setting, a different literary genre.
For a quasirealistic setting - medievalesque low tech and low magic - it helps to end all level advancement at level 8. After 8, each new level gains a level 4 feat instead.
Youth tier (also known as "origin" and level zero). These are typically teens aged thirteen to nineteen (about 5 hit points, simple weapons, background skills and feat, but zero levels in any class). This tier generally represents the youth of reallife: civilians with minimal combat experience, gaining highschool education or medieval apprenticeship, maybe some college or advanced placement. The feat might grant occupational expertise, magical spells, or military enlistment with martial weaponry.
D&D levels really mean combat experience, but for convenience include civilian occupational experience as well. Level 1 typically starts as an adult, about twenty years old.
Student tier (levels 1-4). The tier repesents adult students, seeking a bachelors, in tradeschools, advanced guild apprenticeship in a masters workshop, knightly pages, and selftaught explorers. This tier is the vast swath of humanity in reallife. People are "learning life", with some degree of competence, and can presume some combat experience, training, or talent. The youth tier and the student tier are where, and how, a setting feels real. The students of life are common.
Professional tier (levels 5-8). These are uncommon highly competent individuals, who have established a career or calling. These are gifted grad students toward their masters degree, promising rookie police officers, career military, business entrepreneurs, medieval guild journeyers, and knightly esquires. This tier tends to be the sweet spot mechanically for D&D.
In a low magic setting, competent mages can arise in the professional tier but are rare. Competence is uncommon, but magical competence is rare. Magic from this tier can potentially overwhelm the feel of the setting.
Professional is the highest tier possible if seeking a setting that feels like reallife. If magic is present, the overall magitech feel is something like Game of Thrones. There are wondrous individuals and creatures, but they are rare. The magic inspires cultures but rarely rules a culture.
Many stories end up villainizing the mages at the professional tier, so as to introduce a sense of wonder, but then to keep this wondrousness away from the "normal" people who model nonmagical reallife: hence the genre sword and sorcery. These nonmagical normie heroes might dabble in magic but must eventually give the dangerous or evil magic up in order to preserve the nonmagical norm. Elric novels subvert sword and sorcery by focusing on a villainous mage as an antihero. Harry Potter novels normalize magic by making mages the central heroes of the stories, but then the resulting wizard culture needs to be a secret society in an otherworld somewhere else in order to preserve the nonmagical norm.
When professional tier magic is fully available to a culture, even a secretive local culture, a medievalesque setting becomes impossible. The conveniences of magic feel too much like modern technology. This resulting professional modernesque magitech setting is something like Eberron. Most of its magic is student cantrips and rituals, while professional mages are accessible.
Unfortunately, low magic settings tend to "demonize witches". The alternative is the end of the medieval world.
Master tier (levels 9-12). These four "mid levels" are where the peak of the reallife world record holders and the baseline for the fantastical genre of superheroes overlap. It is where most D&D campaigns end, mainly because of how mid-tier mechanics shift the setting genre. Master is the tier of olympic athletes and scientific prodigies, and also Batman and Captain America - and national heroes of sagas, such as Beowulf.
The availability of professional mages can disrupt a medievalesque setting. The availability of master mages can disrupt a modernesque setting. A culture that avails magic mastery feels distinctively futuristic. This "near future accelerating technology", where sufficiently advanced technology is magic, is my favorite setting. Yet such high magic cannot feel medievalesque.
Despite the presence of rarified reallife individuals that might function mechanically as if in this master tier, the presence of magic operating at the master tier makes a setting feel unfamiliar to typical reallife.
Even scifi genres tend to underestimate the impact of technology. The scenario of Star Trek is impossible. By the time faster than light would possible, each individual would be augmenting ones brain to become the intelligence of a planet. To put "normies" in a starship is itself the fantasy.
Even a small circle of friends who are master mages can shift the feel of the entire planet, to something like Tolkien novels. This is why a normie setting cant have nice things. Normies arent allowed to have nice magic, or any feature higher than the master tier.
Superheroes are how to make sense of the master tier and higher.
Grandmaster tier (levels 13-16). This tier is strictly superhuman, beyond the scope of reallife unenhanced humans, and beyond the scope of 1900s technological modernity. The grandmasters are full-on superheroes, with inherently magical superpowers. Even martial features are selfevidently superhuman magic. Cultures travel by teleportation, elemental magic constructs cities, police scry magically for surveillance.
Legend tier (levels 17-20). The legendary people - the legends - equate each person casting Wish once per day. These are the virtually invincible superheroes, such as Superman and Phoenix. These are the stories of mythic epics. Epic is level 20 plus boons.
Setting. When designing a setting, the most important decision is to determine which tiers of levels are possible.
Default D&D is something like: common student magic, uncommon professional magic, rare master magic, very rare grandmaster magic, and unique legendary mages. These design parameters are high magic. Even tho high tier magic is increasingly rare and out of the way, a medievalesque feel vanishes within these special local settings.
To enforce a medievalesque, low tech, low magic setting means the entire setting is mostly zero level youths and adult students. Professional magic is unavailable to most people. But even the student magic needs to be uncommon. Any characters of tiers higher than master are nonexistent in the setting.