First of all, I really, really like the cover image; really sells the pulp horror thriller theme of Hell and High Water. The layout is for the most part is quite clear, though I almost thrown off by the fact the content of the pages was reversed, with introduction and encounters being on the second page while the confrontation with the main antagonist and epilogue on the first page, however, that was just me not being used to pamphlet adventures.
I do feel some of the text that's backed with colour (such as captain Aalto's stats) might be a bit difficult to read for some people. The text for Crow's Nest is also tricky to read. The Tidal Clock is a neat little mechanic that keeps the players moving, and forces them to balance being thorough with being quick and being thorough. All in all Hell and High Water a solid adventure that can easy fit into a campaign or be run as a one shot.