Top 5 or 10 Desktop Management Tools!

What do y’all use, how much does it cost and does it really work? What do you use for tracking Help Desk requests on a budget — and we’re not talking Heat or Remedy being in the budget!? Is there a better product for imaging than Norton Ghost? What do people use for server tools i.e. to notify Admins when something is badly wrong? Is there a good, solid, reliable product that can back up critical system files without imaging the entire hard drive to conserve on server storage space? What’s out there, and what do you recommend? I work in a healthcare environment so money is a definite issue — along with IT being widely regarded as a necessary if expensive evil. Thanks.