I cannot speak for anyone else, so I will just say what I'm looking to do. I want to be able to sell business cards, post cards, etc. Naturally, this isn't something that can just be added to the cart. It requires a certain amount of customization from the customer for each order.
The best I've been able to come with is to show the template image, and label all the fields that are available. Then I created attribute fields for each part (i.e. name, address, email,etc.)
In an ideal world, they'd be able to edit and adjust the fonts on the screen and wouldn't require any additional work on my part. For now, once an order has been placed, I need to email them a proof of the template with their changes. This is an acceptable work around, but it definitely lacks the customer customization I would like.
I've been thinking about adding the ability for a customer to upload an image (such as a logo or a flyer designed by the customer), but I haven't looked very hard into this option. I have no idea how hard that is to implement into a virtuemart system.