CockroachDB's integration with SQLAlchemy is currently in beta, with ongoing enhancements to improve compatibility. The integration allows developers to build applications using Python, SQLAlchemy, and Flask, with a few necessary adaptations due to CockroachDB's unique features. Key differences include the use of the `SHOW TABLES` command instead of `pg_tables`, the preference for `INT DEFAULT unique_rowid()` over `SERIAL` for automatic ID columns, and the lack of support for foreign keys. A notable aspect of CockroachDB is its use of optimistic concurrency control, which requires handling transaction retries efficiently using the `SAVEPOINT` statement. The tutorial illustrates how to modify a Flask-SQLAlchemy app to accommodate these features, emphasizing the importance of correctly managing restarted transactions with the `cockroachdb.sqlalchemy.run_transaction` function. The example provided demonstrates how CockroachDB's approach enables retry mechanisms by preserving information about transaction attempts, which differs from traditional databases' locking mechanisms.