Designing good looking forms has alwas required a lot of work even with the latest improvement being tables that were introduced i R5(!).
Even using tables and nested tables is a lot of work with table- and cellpaddings, margins, spanned columns and rows. Eventually the tables have tendency to mess up.
Also there are other issues using large text fields in nested tables with autocorrect enabled (SPR # ASHEBBKH74).
I believe the ideal solutions would be a designer area where you can place objects, fields, tables etc. anywhere on the form canvas and enable a "snap to grid" option to make it easier to align objects. This is available in layout regions but it would be nice to have the same possibilities at the Form level. Layout regions for example cannot be centered on the form and it is not possible to include them in a fixed with centered table because layout regions are not supported in tables.
Also, rich-text fields cannot be used and layout regions cannot contain subforms, embedded view, shared fields etc.