`syntax-rules` is very good and you can do a whole lot with them. However, you are limited to template -> pattern transformations, and there are plenty of macros that you cannot write this way. (E.g. anything requiring a predicate on the source syntax that you can't express in the template language, etc.) For that, you need the full power of procedural macros.

Racket improves on Scheme: its macros are fully hygienic whilst not being limited to template -> pattern transforms. See https://docs.racket-lang.org/guide/macro-transformers.html

EDIT: syntax-case -> syntax-rules; R6RS specifies the latter—I believe the former is a Racket construct equivalent in power to `syntax-rules`.