TT,
I run the 3. 73 rear end with a 33 foot, 11,500 lb. (loaded) fifth wheel. I got in the habit of towing in overdrive - because I can (Thanks Cummins) and I'm a fan of low RPM, good for the engine, etc. Unfortunately what's easy on the engine is not always easy on the transmission, and I ended up rebuilding my transmission at 30,000 due to a blown overdrive piston seal, which cost me the overdrive but did not leave me on the side of the road. In fact I went 1,000 miles home in Drive.
I spent about $4,000 and got a hand built trans with all the good hard parts inside, and it has been running well for 15,000 with the trailer, and I still tow in overdrive.
I think you either have to have the 4. 10 gears and stay out of overdrive or you have to expect to buy a transmission. I am happy with the combination I ended up with, because you can't beat the drivability of the custom trans. I had never driven a built truck/trans like that until this one, and you wouldn't believe how much more pleasant it is to drive. It gets rid of that thing where you come off a light and it feels like the engine is making a lot of noise and spinning really hard, but the truck is not going anywhere.
I can now go on trips without the trailer and get 17mpg (2,000 RPM at about 70 with no trailer) because of the 3. 73 gears, and I can tow the trailer at relatively low RPM when I have it attached. Great versatility but it cost $4K. that said, I would do it again in a minute, particularly before I spent $1K on front AND rear gears for my 4wd truck.
If I buy a 2010 - which I am waiting to see in person - I'll put a torque converter in it after I leave the dealership. It really drives that much better.