Running

    coffee -cw *.coffee

will watch all of the CoffeeScript files in a directory and compile them to JavaScript whenever they change, which is what I use for keeping things updated in development, and the production deployment scripts I run compile the CoffeeScript to JS before deploying.

Aside from having to set up a terminal running the compilation task when I start a dev session, the fact that it has to be compiled doesn't affect me at all.