Lots of things work out of the box, but yes, it's still far from being the default. Kensington is releasing an update to its Expert Mouse trackball. The MSRP looks to be USD$150, so not an inexpensive accessory. It supports Windows and Mac but has no Linux support. No doubt in time there will be community supported projects to give it functionality on Linux close to, but not entirely like, what it has on the other two OSes.