Like what did you expect to happen? We're not stupid.
At the place I'm at right now, we have an unlimited policy and I've got 25 days of PTO planned over the course of the year that's all been approved.
But yeah...I do know not every place is that good about it.
At all jobs, vacation time was almost never a problem. Maybe that's more the case now that I'm a freelancer, though. I just announce when I won't be available, and although we do try to plan things so that we never have the entire team gone at the same time (unless the company as a whole plans for that; Christmas breaks are often like that), they always accept my absense. It's really notifications, rather than requests.
But this is Netherland. We've got quite a different work culture than the US does.
He kept getting vacation requests denied due to lack of staffing, yet if he asked if they were looking to hire, the answer was always No.
He was super lucky and had some early cryptocurrency investments pay off big, so he decided he was done with it retired. He said that he loved helping people as a nurse, but not at the cost of his own physical and mental health, having to work 60-80 hours/week. If he ever gets back into it, he would establish at the interview phase that he works 50 hours/week tops, and that vacation "requests" are not requests, but notices.