Keep console open and use reload! when you change your models, for starting a server I don't have much other than keep it running the background, running a test -- use spork, migrate your db and run rake tasks -- try to take advantage of the fact that you can specify multiple rake tasks at a time; "rake db:migrate db:test:prepare"
More good suggestions. I'd love to get spork working, but rspec syntax makes me cringe and I haven't gotten it to work with test-unit. I found a plugin and a fork, neither of which I could get working.
It's a huge productivity killer for me. And as other comments have stated, it's surprising this issue is not discussed more.