No one database is > 200GB so it's not "web scale" by any means but sometimes you need to pull out tricks like indexed/materialised views.
I use Transact-SQL directly via ADO in C++ and ADO .NET in C# and indirectly via EF and NHibernate.
It's easy to manage schema with SQL Server Data Tools and diagnosing a poorly performing query is straightforward with graphical execution plans.
Quite frankly, I don't care that there are alternative RDBMS' or alternatives to traditional RDBMS.
But ... I keep hearing about problem after problem with MySQL. What's the trick to using it successfully? Is the barrier to entry too low, and problems are from legions of rank amateurs? i.e. is it as simple as constructing your schema thoughtfully, with tables that are "well-it's-almost-3NF" and making some educated guesses about which indexes might be needed in advance?