The character creation, simulation, and architectural aspects are significantly reduced and altered to enforce a sharper focus on role-playing-style gameplay.

Listed dangers included low focus on quests, plague, peasant revolts, wildlife, poisons, duels, and more.

Players may also reach "Quest Failed" screens if they do not complete a predefined goal in a predetermined amount of time.

[7] Bernstein conducted multiple media interviews and narrated demos,[8][9][10] and a television marketing campaign was launched.

[16][17] Nicole Tanner of IGN said of the PC version, "The Sims Medieval has successfully breathed new life into a franchise that was getting pretty stale.

Even with its minor flaws, The Sims Medieval mixes a great sense of humor with simple role-playing game mechanics that result in hours of fun.

"[26] Felix Atkin of The Observer praised the game, deeming it as "enchanting stuff set in a beautifully animated and immersive fairy-tale world.

"[35] Video game magazine Edge wrote, "It's a funny and sweet time sink, and something that any Sims fan can wholeheartedly enjoy.

"[5] Greg Tito of The Escapist gave the PC version a score of four stars out of five, saying, "Maxis wagered that adding fun new game elements to its blockbuster franchise would work, and The Sims Medieval succeeds sufficiently to start its own branching franchise.

"[33] Roger Hargreaves of Metro gave it seven out of ten, calling it a "surprisingly daring mix of interactive narrative, role-playing game and life simulator – and nothing like the lazy cash-in you'd expect".

Additionally, the pack introduces pets, new NPC pirates, and a new creature, baby pit beast, which is a new type of Sim death.