I need to be able to adjust the settings, but every time I run the launcher it has a msvcp90.dll error and crashes. And in that state, the graphics are choppy, too choppy to play. I can get the game to launch running wine in windowed mode, but the resolution is set really low by default (640x480 I think), and it's tiny.
I've been trying to figure out what exactly the Launcher modifies to set graphics settings, but I haven't figured it out. My only problem is that FalloutNVLauncher crashes, so I'm not able to set the graphics settings. Running a freshly installed copy of wine, I installed d3dx9 and vcrun2008 with winetricks. I've been able to get the game to run, sort of.