The Fly Machines orchestrator goes through some trouble to keep the source of truth for each VM decentralized, owned by the physical it runs on. But there's still global state --- apps, organizations, services. That stuff is all on Postgres. Postgres keeps up with it just fine but I'd be lying if I didn't say we're always looking out the corner of our eyes on metrics.
The global state for Sprites is on object storage. Each organization gets a separate SQLite database, and that database is synchronized to object storage with Litestream.io (Lightstream is load bearing in a bunch of places here; solid as a rock for us).
I think people really still sleep on the "multiple SQLite database" backing store design.