For me, it would not matter on a long highway trip....id just pull the fuses for the ABS and head to the next town. But if I was in the woods in 4wd and a bead popped, or a tire got destroyed, I'd want a full size matching spare.
If I committed to 37's, and paid to regear, I'd find a way to bring a fifth 37. I think on the Rams, the heat shield(which is removable) and the tailpipe are the limiting factors.
That said, if I was stuck in the mud with a bad tire, I would not want the spare down under the truck anyway.