Is trying to develop for Medium Trust a lost cause?

I started developing a new MVC app with Entity Framework code-first and Unity for dependency injection. I used EF5 and Unity because I thought they were supposed to work in Medium Trust. However, when I threw the <trust level="Medium" /> tag in my web.config, I started getting Reflection Permission exceptions.

It always seems like whenever I go beyond using built-in things like the System.Data.SqlClient ADO.net stuff I always run into problems in Medium Trust. Auto-Mapper: fail. NHibernate: fail. MySQL: fail. EF5 Code-first: fail. IOC: fail.

Am I just chasing a pipe-dream? Is it possible to achieve a well-architected and testable web application using modern technology that will run in Medium Trust?

In the age of VMs/Virtual Servers/Cloud Computing (and even a few shared hosts that will set your application pools to Full Trust) has anyone found developing for Medium Trust to be worth the effort?

Solution

The official position of the ASP.NET team is that Medium Trust is obsolete. This means a few things:

We are automatically resolving all Medium Trust-related bugs reported to us as "won't fix".
We have provided guidance to hosters that they should migrate away from Medium Trust and use proper OS-level isolation instead (http://support.microsoft.com/kb/2698981).
We are removing Medium Trust support from the frameworks we develop (MVC, WebAPI, SignalR, and so on). Going forward, applications built on these frameworks will require Full Trust.

Here, the term "Medium Trust" above to refers to all non-Full Trust configurations in ASP.NET, including use of the built-in trust levels (Minimal, Low, Medium, High) or any custom trust levels.

Edit 26 May 2015: The .NET Framework as a whole has deprecated partial trust, and customers are advised not to rely on it as a security boundary. From MSDN:

Code Access Security in .NET Framework should not be used as a security boundary with partially trusted code, especially code of unknown origin. We advise against loading and executing code of unknown origins without putting alternative security measures in place.