Physically the same
Although it has more controls than its predecessor, the 5N, the Sony Alpha NEX-5R has the same fundamental big-grip-thin-back design as the rest of the series.
More direct access
I expect the top dial and additional programmable function button -- which add another set of adjustments you can dial in -- to make a big difference in the camera's usability.
The 5R adds Wi-Fi connectivity -- you can connect to your phone or an access point for uploading, and the camera will support using your phone as a remote viewfinder.
Like the NEX-F3, the 5R's LCD tilts completely up and automatically enters a self-portrait mode; it flips the image and changes to a self timer. Unlike the F3's, the 5R's display can tilt down as well.
Add-on flash or EVF
It retains a connector for the bundled add-on flash or an optional electronic viewfinder.