You can get an insane amount of performance out of a well-tuned MySQL or Postgres instance, especially if you’ve designed your schema to exploit your RDBMS’ strengths (e.g. taking advantage of InnoDB’s clustering index to minimize page fetches for N:M relationships).
And if you really need high performance, you use an instance with node-local NVMe storage (and deal with the ephemerality, of course).
0: https://hackmysql.com/are-aurora-performance-claims-true/