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How bad is the rust? What year is your truck? If it's so bad that you can fall through it and do a Fred Flintstone, then yeah, you need to replace it. If it's not that bad, you can clean it out with a wire wheel and then prime and paint it, or you can get what's called "naval jelly" at a hardware store and it turns rust into metal that won't rust- dumb explanation, but that's kinda what it does. There are also other similar products out there. Just make sure you always finish with a good protective paint job no matter what you do.
I had a '68 Mercury stationwagon once that had horrible rust in the very back spare tire carrier. I cut a piece of steel plate (16 ga, you don't need anything too heavy) and welded it in place followed by a good primer and then paint. If you do have to weld it in, just make sure you clean the heck out of the joints and cut out all the pin holes you can. THen tack it every two inches or so so it doesn't warp. Once it's tacked in, you want to run your bead in pattern like tightening lug nut again to avoid warpage. Lemme know if you need more help!