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a 4x4 f250 is always (to me) a desireable platform, and for your area, it doesnt look TOO bad, but you would be rolling the dice on the engine. are you prepared to do an engine swap ? expect the worst, i sez.
Yeah, that's the thing with vehicles this old is you just never know about the engine. I am not prepared to drop the cost of an engine, I might as well get a higher priced and working F250.
Yeah, there are a lot of factors that could cause rough idling. These motors are pretty stout, and 138k miles is pretty low, but who knows what the PO did with it.
Rough idling/running could be caused from bad ignition components (plugs/wire/distributor/TFI), sometimes from vacuum leaks, bad EGR valve and more.
From my experience on these motors, I've almost always had it coming from the ignition system (plugs/wires/distributor), or a bad EGR. That's not to say it can't be something far worse like valve-train issues or head/head-gasket problems, but something like that on these motors would stem from heavy neglect or abuse.