For a few months, I've been running my MAME cab at 640x480.  On a lot of games, I would use "-video ddraw" and -"nohwstretch" and "-waitvsync" so there wouldn't be any artifacting.  It would look great most of the time, but a lot of games would not be proportioned correctly.
Last night, I rolled back from Vista 64 to XP 32 so I could use Soft15-Khz.  Things look spectacular now, but I'm running into a few strange throughput issues.
Some games, such as Shinobi, and TMNT, don't run at full speed when I run them at their native resolution AND turn on "-waitvsync" or "-tb".  This is odd to me, because they run just fine at 640x480 with "-video ddraw" and "-nohwstretch" and "-waitvsync."  I don't understand why running them at their native resolutions causes them to slow down.
I'm running on and 4000+ Athlon 64, and on board video and recent versions of MAME.  I really don't think processing power should be an issue.  It seems like far more complex games (Street Fighter 3 and Neo Geo games) run just fine at their native resolutions and vsync turned on.