Scaling phoenix: is distributed erlang worth?

The recommendation is to still deploy those nodes completely independent from each other and have the load balancing work completely independent, as you would with any other technology. The reason to use Distributed Erlang is only if you are relying on a particular library that builds on top of it, such as Phoenix.PubSub with channels and Phoenix presence, and those libraries will already be designed to handle node failures and what not.

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