Games like Surviving Medieval
Games like Surviving Medieval include Oxygen Not Included, RimWorld, Prison Architect, Manor Lords, and Factorio. We matched them by the tags players give Surviving Medieval on Steam (Simulation, Strategy, Indie, Base Building, and Building): closest matches first, and among equally close ones the better-known games.

Oxygen Not Included
Shared: Base Building · Survival · Building

RimWorld
Shared: Strategy · Base Building · Survival

Prison Architect
Shared: Simulation · Building · Base Building

Manor Lords
Shared: Strategy · Simulation · Base Building

Factorio
Shared: Base Building · Strategy · Sandbox

Dwarf Fortress
Shared: Simulation · Base Building · Strategy

Against the Storm
Shared: Simulation · Strategy · Base Building

Space Engineers
Shared: Simulation · Building · Sandbox

Endzone - A World Apart
Shared: Strategy · Simulation · Survival

Kenshi
Shared: Survival · Sandbox · Simulation

Cities: Skylines
Shared: Simulation · Strategy · Building

Empires of the Undergrowth
Shared: Simulation · Strategy · Base Building

Kingdoms and Castles
Shared: Simulation · Strategy · Building

Foundation
Shared: Simulation · Strategy · Sandbox

Workers & Resources: Soviet Republic
Shared: Strategy · Simulation · Base Building

Banished
Shared: Strategy · Simulation · Indie

Settlement Survival
Shared: Building · Simulation · Survival

Ostriv
Shared: Strategy · Simulation · Building

Game Dev Tycoon
Shared: Simulation · Indie · Strategy

Space Haven
Shared: Strategy · Base Building · Simulation

Spacebase DF-9
Shared: Simulation · Base Building · Strategy

Automation - The Car Company Tycoon Game
Shared: Simulation · Building · Strategy

Project Highrise
Shared: Simulation · Strategy · Building

Amazing Cultivation Simulator
Shared: Simulation · Strategy · Sandbox