We used a local firm that I had a personal relationship with (they sponsored the user group I chaired), and they got us a good developer (Rails dev, former Thoughtbotter)

However, even though I'm not actively on the market, I frequently get contacted for .NET gigs (even though that comprises 1% of my work experience, having spent most of my time in ColdFusion and Ruby). More often than not, they're out of state recruiters, and I suspect the actual recruiter is offshore, and they're throwing stuff at the wall to see what sticks.