Tarot Cards are amazing. They can be found throughout the game, be it early floors or towards the end, and can be helpful/life saving at all times.

Given that info, ranking them is no small feat but lets give it a shot. These are the Major Arcana cards, which look like this on the floor:

All these cards are consumables, and can be used once barring Blank Card or Endless Nameless

Also, this ranking is strongly my opinion and based on my style of play. You might have a completely different ordering and thats perfectly acceptable

21. The Magician

Gives Isaac homing tears for the room. The effect is fairly good, and homing with tear effects such as Brimstone or Tech is godly. However it does not stack (how would it even) in case you already have homing through various other sources. And homing helps you land more shots but doesn’t increase your DPS through much else. So it firmly comes in at last place for me

20. The Tower

Spawns 6 Troll Bombs throughout the room randomly, similar to Anarchist Cookbook. A decent way to try accomplish many different things. Dunk enemies around the room, break obstacles or secret room door, or get 6 free bombs if you have Safety Scissors held. However barring the last, its not reliable. It can miss every opponent and obstacle worth breaking, and smack you in the face instead. Even with explosion immunity its alright at best

19. Death

Deals 40 damage to all enemies in the room. Pretty decent early game, when you don’t have tear effects like piercing or high damage and could be overwhelmed by enemy mobs. Usefulness drops off the cliff once the mobs get strong enough, even as early as third floor onwards. However it has zero downsides to it so its never a bad one-use no regrets card

18. Wheel of Fortune

A tricky one to place. Spawns an arcade machine (slot machine or fortune teller). This one scales in usefulness the further you progress. If you have the coin, Khaljit the machine has the wares. Slot machines can give you handy consumables or even a Pretty Fly orbital. Fortune tellers can give you cards and runes, trinkets and even soul hearts. And on the Chest/Dark Room, blowing up either with a bomb gives a free item. However its unpredictability prevents it from a higher rating

17. The Lovers

Not as tragic, but surprisingly slept on. Spawns 2 red hearts on the floor. If you are playing a red heart container build its fairly obviously good. Also helps with demon beggars/blood donation machines/IV bag for items and coins. But even if you are playing a soul/black heart build, it can be used. You have to find one of the super secret rooms which have the Library/Angel floor layout. Using this card will spawn black/soul hearts x2 instead of red hearts. The latter advantage is slightly unreliable but a solid card nonetheless

16. The Hanged Man

Decapitates Isaac, leaving him as a floating head with flight for the current room. Flight is always amazing. It helps with manoeuvring around enemies, especially if you float over rocks. But it also allows you to pick up inaccessible consumables and items. Some items in fact are impossible to reach without flight, and this annoying room design is prevalent in the Basement:

15. Justice

Spawns a heart, a coin, a bomb and a key on the ground. Also plays the Justice League (TV series) theme song in my head but that might just be me.

Pretty straightforward in its utility. However the consumables dropped aren’t fixed. You can get a golden bomb, charged key, nickel/dime, and any heart. So it has decent utility especially early on (beware: can spawn a troll bomb)

14. The Devil

Grants a +2 to Isaac’s damage for the room, and makes him look very cool. Tempted to put it higher for the looks aspect. A very solid one time use, can be very helpful for extra DPS with no downsides. However its only a damage upgrade and does not stack with either multiple uses of itself or Book of Belial. Save it for bosses

13. The Empress

God save the Queen. But maybe she doesn’t need it, with an increase to damage and speed, and a cool pair of horns. Gives a little less damage than The Devil, but stacks with Whore of Babylon and itself which makes it very OP with Blank Card

12. The World

Time has stopped. Sadly not the effect, it instead shows you the entire map of the floor with the exception of the Super Secret Room. A very handy benefit, if you have low health you can now reach the boss most efficiently. If you have a single key and want to differentiate a shop or a library, a dice room versus something else. And its not redundant unless you have The Mind. Completely ruined by Amnesia/Curse of the Lost though

11. The Fool

Teleports you out of any room and back to the starting room of the current floor. All the teleport items are clubbed together, and The Fool is the least helpful of them all. Mostly good for escaping Curse Rooms and Challenge Rooms

10. The Stars

Teleports you to the Item Room if the floor has one, or a random non-special room if it doesn’t. Saves you one key and gives you an item for the floor right away but not much else to it. Free teleports are nice

9. The Hermit

Teleports you to the Shop if the floor has one, and random non-special room if it doesn’t. Same boat as the previous card, but slightly helpful if you aren’t sure which room is the Library and which is the Shop. Plus a saved key

8. The Moon

Teleports Isaac to the regular Secret Room of the floor. Honestly not much different from the previous two, saves a bomb instead of a key, especially when you know where to find it with experience. But it does save the confusion for beginners and intermediates, and even experienced, lazy players when they can’t see the map

7. The High Priestess

Summons Mom’s foot to smash down one enemy, hitting everything it smashes for a whopping 300 damage. Thats an easy boss-dunker right there, even for later floors. Just make sure there aren’t other enemies away from the boss when you use it. It can also act as an emergency bomb if you truly need it, and the cost of getting Isaac some head trauma. Just use it in a room with no enemies and Mom will lovingly stomp Isaac instead

6. The Hierophant

If you didn’t realise it yet, I really love Soul hearts, and Hierophant spawns two of them so I love it twice. Zero downsides, just don’t use them in the Super Secret Room that converts them into red hearts (unless you want to, you weirdo)

5. The Emperor

Teleports you to the Boss room for the floor. The single biggest fuck you to the entire floor: curses, mobs, layout and everything. Go straight to the boss whenever you want. Holds more value the further you progress. Extremely helpful for meeting time-constraints, be it for Boss Rush, Hush, challenges, dailies or achievements.

4. Temperance

Spawns a blood donation machine (in Greed mode it spawns a demon beggar). Extremely flexible card which can provide emergency cash at the cost of spare hearts. Given the prevalence of red hearts, it trades them for valuable coins, until it breaks. Upon breaking it gives you a full heal + health up or the IV bag, both of which are very nice additions. If you have items that proc on taking damage such as Bloody Lust (Samson) or Cambion Conception, it helps out with damage immensely.

3. The Chariot

Do you hear that Tokyo Drift music? This card gives you temporary invulnerability and contact damage, like the active item My Little Unicorn. Has a variety of uses, such as getting out of danger and if you have an orbital, obliterating your foes. It allows you to go over spikes and leave sacrifice rooms free of cost. It also lets you abuse demon beggars and blood donations for the entirety of its duration

2. Judgement

Spawns one beggar (Coin, Demon, Key or Bomb). Mostly the first two. At worst, you can bomb these beggars for an increased Devil/Angel chance and/or consumables and trinkets. But they can also be played to give a variety of goodies. Demon beggars especially give items from the Devil pool and can be very rewarding. Also, all beggars can be bombed on The Chest/Dark Room for a free item. It is recommended to play the Key Beggar on that floor, because every chest it gives is a free item

1. Strength

Do you even lift, brethren? This card gives you Magic Mushroom for a single room, with all stats increased except tears and a temporary red heart container. Does it stack with Magic Mush/Cricket’s Head? The damage multiplier doesn’t but you get a slight increase. The real utility is with the temporary red heart. It allows you to essentially steal a Devil Deal when you have no red heart containers, thereby saving you two or three Soul Hearts. You can also use it with Potato Peeler with no red hearts for a free Cube of Meat upgrade, or with Guppy’s Paw for three free Soul hearts

0. The Sun

Most items do one or two things at most. This god-tier card restores you to full health, deals a solid 100 damage to all enemies in the room and also reveals the current map for the entire floor minus the Super Secret Room. Thats like 3-4 cards worth of work in one. Always a delight to find and use instantly or save for later even

So there you have it, let me know your thoughts in the comments, whether you agree or disagree. Here is the TL;DR list:

The Sun Strength Judgement The Chariot Temperance The Emperor The Hierophant High Priestess The Moon The Hermit The Stars The Fool The World The Empress The Devil Justice The Hanged Man The Lovers Wheel of Fortune Death The Tower The Magician