If the hardware supports it, the nvidia binary blob will let you specify 15kHz scanrates. There is a minimum pixel clock, though, so 320x240p type resolutions may not be usable on most hardware. 640x480i or 640x240p (just do a 2:1 horizontal scale - the output signal is then identical to 320x240) are usually supported.
Some hardware needs the monitor to provide EDID information saying it can support the low scanrates. The hardware will refuse to do what it's told (!!) without this. SailorSat was building little dongles for a while that provided the necessary EDID information and plugged in-line with your VGA cable.
Note that not all nVidia hardware supports this stuff. I've used the 6000 series with some luck, but that's pretty ancient at this point. The newer hardware is apparently more problematic. You may also have to use older versions of the driver; I don't know if the newer ones have busted this stuff.