I'm aware of all the NPC lag issues, but there are also other people who say that they are running it just fine. I'm not sure what to think, so hopefully someone can help me out here.

Here's my rig.

Intel QC 9450 (OC'd to 3.2 GHz)
8GB DDR2-1066 RAM (6-6-6-18) Corsair Dominator
EVGA GeForce GTX 285 1GB
Windows 7 Ultimate x64

Mostly, I have lag issues when viewing NPCs (FPS drop). No matter the resolution I run it at, if there are more than one or two NPCs on the screen, it drops to 8 FPS: absolutely unplayable. It's set on high as recommended by the launcher. I have also forced the nVidia profile to use maximum performance (as opposed to prefer power savings). I have also tried different versions of the drivers. So besides changing drivers and editing the profile, what can be done about this?

Of course, there is clearly something wrong with the game that needs to be patched. But if I have to upgrade my video card to play on Ultra High (I don't think I should, considering that I can still play many modern games on relatively high quality, and Fallout 3 on max), what would you guys recommend?

Thank you everyone.

It's an issue we all pretty much get. Download this, pop it into your ...\Steam\SteamApps\common\fallout new vegas\ folder. Re-run the launcher, it'll detect your graphics as medium, this is normal. Just set them back to high or w/e you want and run the game

http://www.newvegasnexus.com/downloads/file.php?id=34778

Hmm...I don't know how I missed that one. Thanks so much, I appreciate it! I get the feeling though that the graphics don't look as good with this DLL (even though I set it all back to ultra), though it could very well just be all in my head. Anybody else feel that way?