It can be a hassle at times, but it's still awesome. A lot of depends on the type of camping you do, the type of terrain you go on, what kind of tent you get, your vehicle, and a million other things. So what might be a complete waste of money for one person can be the ideal setup for another. I just spend 4 days in Death Valley with my RTT on top of an FJ40, the so the reality of using one is still fresh in my mind.
My reality:
They're heavy. No question it's makes a vehicle top heavy, but the effect can be anywhere from extreme to minor. A tall, top heavy, underpowered, short wheelbase vehicle like an older jeep or FJ40 is probably the most inappropriate vehicle for a RTT, and I wouldn't recommend buying one for that purpose. Can be done, but the effect on handling is very dramatic. If you do a lot of off camber trail crawling, it's going to suck. Going over Cajon pass with a headwind feels like you have a parachute on your car. Mileage will suffer. However, on a newer, lower CG car, a RTT is almost unnoticable. I've had mine on a subaru and minivan and other than some wind noise I don't really know it's up there.
They're expensive. Per square foot it's probably the most expensive means of shelter
Can be a pain to install. It's possible, but not easy, to install one solo on a lower vehicle. One person with a hoist is ok, but not quick. Two tall people make it fairly painless. If you have a dedicated camping vehicle and a tall enough garage to park in where the tent stays attached, it's not a problem. If you use it on your daily driver and have to install and uninstall every trip, it's a pain. On my last day in DV, I had a really long drive back, so I actually removed my tent and threw it in the back of my friends 4runner. The 20 minutes I spent takin off the 4 bolts probably saved me a couple hours in driving time.
They are sometimes easy to setup, sometimes not. For a folding RTT, can be anywhere from 1-10 minutes (or more if you want to add the annex) a lot of it depends on how tall you are in relation to your vehicle. Some of the new ground tents setup extremely quick, so at best they're about equal in time to setup, but the RTT has the advantage that your sleeping arrangements are already contained in the tent once it's setup, so you don't have to deal with sleeping bags, mattresses or cots. At worst case, a short person with a tall vehicle, the tent is going to be a hassle unless you are comfortable climbing on your vehicle or have a ladder. It's still slightly quicker to setup than an older style, family size tent. The hardshell seem much quicker and easier, but I've never used one.
Finding a decent tent site is no problem. I don't have to worry about rocks, bushes, thorns, anthills, mud, whatever. As long as I can get the vehicle fairly flat, I can setup a tent. Even on a slope, it's easy to level the car by stacking rocks or firewood, compared to finding a flat spot for a ground tent. The mattress covers 100% of the floor so no sliding off the mattress onto a rock in the middle of the night.
Stays cleaner. It's not on the ground, so mud isn't a problem. Also seems to get less dirt in, maybe because it's higher off the ground? I don't know the exact reason why, but I don't have to sweep it out as often.
There are some intangible benefits to a RTT that you won't undertstand until you use one. One, It's just cool. There's just something about being off the ground that excites the inner kid in me, it's like sleeping in a treehouse. My family loves it, which means I get to go camping a lot more. I know some people see fun and comfort as a weakness, but the wife and kids aren't interested in proving how tough they are by sleeping on the ground, all they care about is enjoying themselves, and the RTT is definitely fun. Two, there is some sense of security to being off the ground. I don't think there's any practical security benefits to a RTT, but even the false sense of comfort is great when you have kids camping out in the middle of nowhere.
I've only seen the Yakima skyrise at REI, haven't used one personally. I was really excited before they came out, I thought about trading my Tepui for one. But after seeing it in person and looking at the reviews, I'm not all that impressed. What I was really hoping for was a better mounting system to the cross rails. The yakima looks more convenient, but it's also much taller than the current mounting brackets, which I didn't like. Also, I thought it would be much lighter than the existing tents. But it's only 10-15 lbs lighter than a comparable canvas RTT, so the tradeoff in durability doesn't seem worth it for that small of a weight savings.