Games like Altwaldheim: Town in Turmoil
Games like Altwaldheim: Town in Turmoil include Foundation, Against the Storm, Cities: Skylines, Prison Architect, and Manor Lords. We matched them by the tags players give Altwaldheim: Town in Turmoil on Steam (City Builder, Roguelite, Building, Management, and Medieval): closest matches first, and among equally close ones the better-known games.

Foundation
Shared: City Builder · Medieval · Management

Against the Storm
Shared: City Builder · Building · Strategy

Cities: Skylines
Shared: City Builder · Building · Management

Prison Architect
Shared: Building · City Builder · Base Building

Manor Lords
Shared: City Builder · Strategy · Base Building

Kingdoms and Castles
Shared: City Builder · Management · Building

Tavern Master
Shared: Management · Building · Medieval

Farthest Frontier
Shared: City Builder · Building · Medieval

Stacklands
Shared: Roguelite · Management · City Builder

Cities: Skylines II
Shared: City Builder · Building · Management

Dwarf Fortress
Shared: City Builder · Base Building · Management

Frostpunk
Shared: City Builder · Building · Strategy

Workers & Resources: Soviet Republic
Shared: City Builder · Strategy · Base Building

Banished
Shared: City Builder · Strategy · Medieval

Ostriv
Shared: City Builder · Management · Building

Planet Coaster
Shared: Building · Management · Strategy

Two Point Hospital
Shared: Management · Building · Strategy

Kingdom Two Crowns
Shared: City Builder · Building · Base Building

Settlement Survival
Shared: City Builder · Building · Management

Oxygen Not Included
Shared: Building · Base Building · Management

Stronghold Crusader HD (2012)
Shared: City Builder · Medieval · Building

Empires of the Undergrowth
Shared: City Builder · Base Building · Strategy

Kingdoms Reborn
Shared: City Builder · Management · Base Building

Dyson Sphere Program
Shared: Building · Base Building · Management