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What I do in AWS is having a VPC with 3 subnet types, public, private and restricted. Public ones have default route to inet, private to NAT, restricted - none. DBs go in restricted, load balancers in public and web/app servers in private subnets. Plus whitelist firewalling using Security Groups.

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when i evaluated using a NAT setup using AWS NAT gateways it appeared to be quite expensive. we settled for strict VPC rules using only SecurityGroups in order to restrict communication. the instances did have public ip but nothing but intended services could connect to it anyways... i.e an instance running a HTTP API could only be connected to if initiated from the load balancer and itself could only connect to relevant services such as a RDS cluster...

Normally machines behind NAT use it only for pulling stuff on boot time. Main traffic goes via LBs. depends on your case, of course.

later on they also had the need for it to be honest, albeit only for a very specific external service that required us to have a fixed public IP address to connect from. The only solution deemed scaleable was using such an AWS provided NAT Gateway..

so yeah, it surely depends on the case given...

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