For many(if not all) small and medium size business time and cost matter a lot.
That's why languages, frameworks, tools, and services that are easy to use and provide 0 to productive in less time, it's best.
Maybe Node.js frameworks might provide better features compared to Rails but in terms of MVPs, for us Rails is the leading alternative.
Amazon EC2 might be cheaper and more customizable than Heroku but in the initial terms of a project, you need to complete configurationos and deploy early.
Advanced configurations can be done down the road, when the project is running and making money, not before.
Finally, comunication and keeping a good history of conversations, decisions, and discussions is important so we use a mix of Slack and Twist