Cost-wise midi means 20-30$/€ additonal parts (controller, darlingtons, opto, transistors, quartz, caps, Rs, jacks, 5V regulation, sockets . . .). Also the transfomer needs to have an additional secondary, which makes it more expensive.
Technology-wise few builders have access to the software. Although nowadays there are even OEM manufacturers who offer it for internal purposes (I think RJM has a PCB for builders). My guess is that this is the biggest challenge for most.
Room-wise it means that you need (depending on the size of the amp) more room for the parts (if non-SMD is used). And you definitely need to be able to work PCB only. Min size for additional midi is estimated 10x8cm. Not a big deal in a full size amp like Herbert, but in lunchbox amps . . .
My guess is that we will see more midi amps in the near future. The reason is that VTL switching is obsolete due to ROHS guidelines and there aren't any left manufacturers for the old Fender technology, which is also used by Soldano and Boogie. They have to look elsewhere and when complexity is more on the higher side like in some Boogies they need to go midi now or use at least proprietary switching techn. with controllers to avoid the downside of multiple switching like switching noise, popping and so on.