One of the nice things about a dually is that in many cases you really don't need a spare, provided you do a little prep beforehand...
On duallies usually all six wheels are the same (if they're stock), so any wheel can be used in any position.
Unless you have the misfortune to have a tire completely shred, or get a flat while heavily loaded, a flat on the rear means simply driving to a tire shop to get it fixed, maybe at a reduced speed. A flat on the front though doesn't mean you're out of luck though, provided you had the foresight to carry either a second jack or a jackstand in the truck. With that it's a simple matter to swap the flat on the front with one of the good tires on the rear, then drive to a tire shop.
On my GMC dually I have a pair of 6 ton stands and a 3 ton floor jack (in addition to the regular jack), so unless I get two flats, or have a heavy load in the back that one tire won't handle while driving, it may take a little longer to get going again but I probably won't be stuck anywhere.
Actually, since I buy cars for a living, I have very good access to towing and transport services no matter where I am. I'd probably just call a flat bed to pick me up if I ever had a flat.
Mine is stored underneath the truck accessed by a winch type of cable system that lowers it down. I've only had to use it one time. The day I buried my little brother I walked outside to find my truck sitting on a flat. I went back inside to change out of my suit so I could change the tire. Luckily I was not late for the funeral.
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