I adore the style here; the white, black, and orange colour scheme along with the featureless silhouette of the lost and the Pillars is striking and adds to the theming. The mechanic are the real selling point for me; I don't think I've seen someone use a dicetower (as in a tower of dice) as a means of tracking your character's health. This creates a death spiral that makes the game well suited for those who want horror/post-apocalypse oneshot.
However, I can't help but feel there could have a tiny bit more; maybe a table to determine the nature or appearence of a lost. Still its really hard to criticise a one page RPG because they do so much with so little and all things considered, These Pillars Remain does what it sets out to do, that is to make sure everyone is at the edge of their seat when someone rolls a 1.