While not one you're likely to see at the regional level, the ANJYO REVERSAL 1 in Nagoya, Japan (RJGG) is a challenge, especially off Rw 36, when being flown with the FMS on the fritz.

It is the DP to expect out of Nagoya, and they always make you do the DME arc stuff for noise abatement. ATC outside the US just assumes everyone has FMS's, which make any non-visual procedure a non-event, just follow the cues.

The River Visual 19 (or the Expressway Visual to 31 @ LGA) is the approach I miss most from my days flying smaller aircraft - great fun and scenery. It is a sad day when visual procedures are being talked of as 'the hardest' - they're all visual, old fashioned, hand-flying. On a nice CAVOK day, turn off all the fancy automation and fly the plane the old fashioned way. From a Cub to a 747, they all fly the same!