You can drive with a hole in your exhaust and the vehicle will run and operate just fine.
However depending on where the hole is in the exhaust it could eventually leak exhaust gases and carbon monoxide into the vehicle.
If you get exhaust gases inside your vehicle you can get headaches and even pass out and die especially if the windows are up.
So it's best to have the hole in the exhaust repaired especially if it's underneath the cab of the truck or underneath a car that could cause the exhaust gases to get into the vehicle.
I have a small hole in my exhaust under my truck but it's under the truck bed so I don't exhaust gases in my vehicle.
The exhaust system is gonna get replaced soon anyway so I'm not fixing it.
However if it were under a car I would fix it to prevent the exhaust gases from getting into the vehicle.