1. The incessant heat. This must be the worst problem because it prevents me (and a lot of others) from going there at all the hottest time of year. People could (and I'm sure do) die from it. Loss of power, for at least a fan, can be a life or death situation.
2. Crime and lawlessness. This is a close 2nd. Unfortunately, since it occurs in all seasons, if I start cancelling trips because of it, when can I go back at all?
3. The noise. It is not "pollution" because it is intentional - therefore there is no chance that anything will be done about it. Domincans' hearing is damaged, probably in the womb, and therefore requires progressively louder and louder sound to hear at all. It's a viscous cycle, similar to that of a drug addict - they're "sound addicted". Sometimes I actually wear hearing protection from a gunshop.
An almost comical example is the way that they congregate at telephone call offices for group discussions, of all things, completely oblivious to those who are there to place a call.
Those are the 3 big ones. Most of the others have at least some sort of work-around.
4. Power outages. Planning (inverters, etc.) helps a lot. So does spending time in the campo with a different lifestyle.
5. The general lack of consideration for others.
6. The way that gringos are cheated. If one plans on frequent trips, he has to cultivate a Dominican (that he can trust at least halfway) to "front" for him.
7. Water outages and lack of potable water. The outage problem would be even more serious if it happened more often. Luckily, one can usually buy bottled water (albeit of questionable integrity, as everything is in the DR), otherwise this problem would be much bigger.
8. The way the airlines get into the act and gouge travellers by charging fares that are often several times as much per mile as to other destinations.
9. The way the telephone companies get into the act and gouge callers by charging tolls that are usually several times as much as to other destinations.
10. The way some people (usually those who have seen little of it except for AI's and other tourist areas) refer to it as "paradise" - something like the 3 little piglets huddling together for mutual support while they sing "Who's afraid of the big bad wolf".
In short, one has to constantly remind himself why he is in the DR in the first place, and that some things are more important than others (whatever that might be to him).
REMEMBER WHERE YOU'RE (AT).