Rank 19 is the rank following Rank 18. This rank unlocks Patcheye, who automates and speeds up Clinics, and Nurse Wretched, who decreases the cost of the Placebo industries. Rank 19 has 13 Missions, and at least 10 of them must be completed in order to rank up to Rank 20.

# Name Requirement Reward
1 Promote Researchers Upgrade 3 Cards Stone
2 Science Rules! Collect 900 Science Stone
3 Grow-It-All! Own 65,536 Irrigations Wood
4 Sewer Pursuer Own 131,072 Sewers Wood
5 Armed and Glorious! Collect 8 FF Bullets Wood
6 Glass Walls! Own 5 M Greenhouses Wood
7 Duck and Coal! Own 20 M Coal Plants Stone
8 Precision Care Own 2.5 M Clinics Wood
9 Bustling Bunkers! Own 16 M Bunkers Wood
10 Land in the Hand! Collect 50 LL Land Stone
11 Ambulance-A-Lot! Own 270,000 Ambulances Wood
12 Glass Walls! Own 74 M Greenhouses Wood
13 Rail Sale Own 333 Trains Stone

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