Yes, PIP on Windows.
The problem with Visual Studio is that it refuses to install the bulk of its code on the system install drive, which in my case (and a lot of people's cases) is an SSD with relatively limited space beyond the operating system core itself. And no, you can't tell it to install elsewhere. It's been brought up to Microsoft that this is perhaps one of the worst install non-options ever seen, to which their response is a dead eyed stare.
pycrypto is the problem, no doubt. The fact that it is an abandoned project only multiplies the issues. Apparently, the migration path is to go off to pycryptodome, but reengineering the steem module to use a different crypto hardness is well beyond the level of "being responsible" that I want to get into.
Really, what I want is a decent Python-side module for dealing with a lot of steem data. The MongoDB interface on SteamData is very nice, and I like it a lot – but it doesn't allow for interaction and that would be nice.