> And as that blog post mentions, it recommends using ETS but Google says ETS isn't distributed. So now suddenly you're stuck only being able to work with 1 machine.

There is a mostly API-compatible distributed version of ETS in OTP, called DETS. And a higher-level distributed database built on top of ETS/DETS called Mnesia, again, in OTP. So, no, you aren't.

> I know you can do distributed state in Elixir too, but it doesn't seem as easy as it is in other languages. And it's especially more complicated / less pragmatic than other tech stacks because almost every other tech stack all use the same tools to share external state so it's a super documented and well thought out problem.

You can use the same external tools in Elixir as on platforms that don't have a full distributed database built in as it is in the OTP, so, I don't see how the fact that those external tools are widely used on other platforms makes Elixir harder.