What about looking in a different place? As in another country where they sell them, and import. Yes, shipping, emissions, highway safety etc. that will most likely need to be brought to standards. But think about it, you most likely can get what you want. just sayin'
Fun cars, sure... I've done that. But not a truck. It's just a tool to me, not a passion project.
If I were to buy a new truck, and I'm considering it now, I'd want this...F250 4x4 work truck, especially no carpet. 6.8L gas.
A truck...nothing more
This is almost exactly what I was looking at this evening, but one level up in XLT, just to get cloth instead of vinyl seats. I need to find time to play around with their configurator, as it appears the 7.3L is only another $1500. If both engines have similar reliability ratings, and choosing one versus the other doesn't force other options packages I don't want, I see no reason to ever choose anything other than the biggest available.
Like you, I don't need or want carpet. I throw away the carpet floor mats and install rubber mats in every truck I own, anyway. But I'm not sitting on vinyl on our -10F January mornings! Heck, they're equally bad in July. I'm not spending money to put leather into a pickup truck, where I'd likley just rip it anyway. So I'll take cloth, thank you!
Speaking of seats, that is the
one good thing I can say about auto trans, I guess... I do use my remote start almost every F'ing morning in winter, and have the heated seat set to come on and be warm before my rear ever hits it.

I still have PTSD from a childhood spent waiting on cold vinyl car seats to warm up, while dad scraped ice off the car windows.
The 250/350’s are steel right? Or are they aluminum now, too?
Aluminum, which is honestly the only reason I'd even look at Ford. But I'll admit... I'm looking!
I have a 24' RAM 2500 w/ the Cummins. So far I really like the truck. I was a Ford guy but kept having issues with them.
Putting rust aside, my two Rams are the most reliable two vehicles I have ever owned, by a very long shot. I can't say enough good about them, in that regard.
But I'm also getting real tired of replacing trucks at 50k - 70k miles, when the doors, tailgate, and bed rust out. If Ford can solve that problem, they're at least worth a look.
Edit -- forgot to add -- Standard Cab???? Could never go back to a standard cab where you can barely shove a windbreaker behind the seat. A full crew cab is SO much more utilitarian and versatile.
Again... agreed. It's awful hard to keep luggage dry in an open bed, driving to the airport in the pouring rain, or to lock up anything while traveling. Extended, Quad, or Crew cab solves all of these problems, and gives more space for hauling passengers when needed.
OP, is a used pickup to your spec from the South West desert states a realistic option?
Maybe! Although the last vehicle I bought sight unseen ended up being an undisclosed smoker's car, so heavily perfumed with detailing products that I couldn't tell until all that chemical wore off. Took probably more than a year to stop getting ash out of the vents and every crevace, and for the truck to stop smelling like an ash tray everytime it'd be humid or raining.
Driving yourself to the Doctor would be so much more fun with an automatic!
Just a few days ago, I posted about making my buddy shift my 5 on the floor Chevy pickup while I drove with a broken shoulder and ribs.

Even my 12 year old knows a standard 6-speed shift pattern today, so an upper body injury could still be managed. But yeah... broken legs are tough with a clutch!