Putting a spare on a dually is typically not much harder than putting one on the steer axle of the same vehicle. Usually it's the same weight and number of lug nuts tightened to the same torque. On something like a Ford E-series chassis, it's really quite doable; the wheels are a bit heavy, to be sure, but not unmanageably so, and the lug nuts are torqued to 140 foot-pounds, well within the capability of a breaker bar or decent lug wrench to loosen. The only difference between the front and the back is needing a socket extension (as the lug nuts are inside rather than outside the wheel dish) and, in the case of an inner wheel, having to take the outer off and set it aside temporarily. There is more weight to jack up, too, but if you have a sufficiently powerful jack that's not a problem.
It may well be true that a majority of motorhomes do not come with a spare, and I suspect that's more true the larger and heavier the chassis is. 19" and especially 22.5" wheels are a good bit heavier and harder to manage, and typically have significantly higher torques required for the lug nuts, making it rather harder for average people to change them out. Some chassis also have different wheels for some or all of the positions.
For typical class C's, I think spares are often available at least as an option. Certainly it's not problematic to get a suitable wheel from Ford or whomever and mount a tire on it. There may not be good provisions for carrying it, though. (Mine has an underframe cable hoist system that works out nicely for me.)