Better yet - they boot from USB now (and even NVMe if you're using a CM4).
The biggest downside is your PXE server going down is going to kill all the Pis, so if you are doing something important you need a highly-available PXE setup. And if you have that, it's probably a better place to host a lot of the services people use Pis for in the first place.
I've setup a small office with 5 lines + 10 extensions all running on one of those (+ an analog line adapter), and it's been trouble free for the 3-4 year uptime so far.
Sadly, as our usage of the IP phones dwindled (cell phones, texting, and now conference software taking over), my significant other began evicting them from around the house ("too big and ugly"). A couple years ago, my instance was at the point I needed to do some major OS upgrades to it, and considering it was basically my office phone and a cordless left, I ended up retiring the Pi and PBX. Now I just register my last couple phones directly to my VoIP provider.
It looks like a Pi 4 can handle "dozens" of simultaneous channels (though depends on codecs used), and that would be my starting point if I got back into doing PBX work or deploying a system today -- though I'd probably run it from an SSD instead of SD card.
This is a great example of the benefits of the Pi hardware, too: People don't tolerate PBX downtime. With the Pi, it's incredibly cheap to have hardware for a failover server (try pricing that out on a commercial PBX!), and in an emergency you can run out and buy one locally or have it shipped overnight.
It's a good target if you want to provide something very close to a "turn-key appliance" without actually selling your own hardware: You can provide an image that a user writes to a microSD card, plugs in, and it just works.
For example: HomeAssistant [1] for home automation, OctoPi [2] 3D printer software, OpenElec [3] media center, RetroPi [4] game console emulator, Volumio [4] music player, and lots more [5].
[1] https://www.home-assistant.io/installation
[2] https://octoprint.org/download/
[3] https://openelec.tv/
[4] https://retropie.org.uk/
[5] https://volumio.org/
[6] https://github.com/thibmaek/awesome-raspberry-pi