Basically you have increasingly sophisticated symbology and labelling options depending on your requirements. At the top end you have functionality that effectively allows you to recreate a national mapping agency within ArcGIS Desktop (see Production Mapping for more details). If you are familiar with Ordnance Survey mapping this is the kind of quality I am talking about. It's a serious engineering task to put together the toolset and workflows to get anywhere near this. Nothing open source comes close (awaiting OGC true believers..).

That is to say, it's still not perfect, but as far as I'm aware it's near the best COTS option available.