There are alternatives to the surface mount wall evaporators. They made ceiling cassettes, slim wall units, etc.
Personally, I like the idea of mini-splits in homes w/o ductwork. They are efficient and affordable. One distinct advantage I tend to like is that a failure doesn't mean the whole house becomes unbearable. Inevitably, HVAC normally fails in extreme weather and Murphy's Law says it will happen at 1 PM on a Saturday, after all the parts places and service companies are closed. With a central unit this means it may get pretty unbearable; with mini-splits your home is still comfortable and putting a fan in the doorway to the room w/ the failed unit can improve comfort there. Another advantage is the benefit of shutting down single rooms w/o having to close vents (and throw off the airflow balance).
That being said, with an open floor plan you can go with fewer, larger units to reduce costs. Obviously putting one in every room of a closed-plan house can be costly, probably on-par with the cost of a central unit plus duct installation.