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Realism in a story is very subjective. Margaret Attwood's novel, The Handmaid's Tale is set in a dystopian future that is ubelievably weird. As you make your way through the story though, it all starts to make horrible sense, and by the end it is all too believable.
As long as your world is homogenous and holistic, you can probably get away with just about anything. Attwood started by simply asking the question "what if... there was a massive drop in the birthrate?" Gilead was one of the possible outcomes. You have to admit, it would have been too full of story potential to turn away from, so she didn't.
In the end, stories are about people. Forget the plot (although you'll need a good one), it is the character that makes the story compelling. People are products of the world they inhabit - forget that fact and your story starts to fall apart. A story with compelling characters in situations that are fairly alien to them (all stories boil down to the 'fish out of water' scenario), set in a world that makes sense to the character, is fertile ground for a page-turner.