SQLCE v4.0 is still available and is thriving. You can easily use it with any edition of Visual Studio 2019. You don't even have to install it—you can distribute it as a Private Deployment, bundled with your app.
Install this package, set some configurations in your project, and you're off and running.
It works great with Entity Framework 6.x Code First Migrations. I've had apps in production for years that use it. I couldn't be happier.
Here's a snippet from my data context class:
Partial Public Class Context
Inherits DbContext
Private Sub New(Connection As SqlCeConnection, LogSql As Boolean)
MyBase.New(Connection, True)
Dim sSessionSql As String
Database.SetInitializer(New CreateDatabaseIfNotExists(Of Context))
Database.SetInitializer(New MigrateDatabaseToLatestVersion(Of Context, Migrations.Configuration))
Me.Database.Initialize(False)
If Utils.Registry.LogSql OrElse LogSql Then
sSessionSql = String.Empty
Me.Database.Log = Sub(SqlCmd As String)
sSessionSql &= SqlCmd
EventLog.WriteEntry("SQL Log", sSessionSql, EventLogEntryType.Information)
sSessionSql = String.Empty
End Sub
End If
End Sub
...
End Class
As you can see, it creates a new database at startup if one doesn't already exist.
As a one-man ISV, I'd be out of business if I had to force my customer to download a +60MB installer just to run my small utilities.