Recently I returned a heatsink for my video card because I found that I didn't have enough clearance inside the chassis for it to fit properly. It was just a tad off, but enough to cause problems. Customization is a big deal for enthusiasts, and dealing with frustrations such as the one above is something we all run into when building our own. This unique video card solution from ASUS caught my attention because of this. Based on the beefy (and slowly becoming affordable) X800, this video card has a positionable heatpipe that attaches to the card. This is fantastic - there are three positions available, letting you choose the best based on airflow and chassis design.
The card is slightly underclocked by default, but also is completely passively cooled. According to the review it overclocks decently, and coupled with the passive cooler could make a good buy for $250. It isn't that much above a run of the mill X800, but customization is fantastic - and this is one that lets you have some out of the box without having to buy a 3rd party heatsink. We're seeing cards ship with water coolers too, these days, and it's a positive sign to see the industry respond to the demands of the niche elite PC market.