I use the free tool TerraMaker with some success. But the coolest feature I have yet come across for sculpting was in Bryce. It had the ability to apply a global effect, say Spikes or something, then back that out and re-apply as a brush on feature just where you wanted. So you could make almost anything a paintable effect, Erosion, Lowering, Posterizing, Noise, you name it.
That would be way cool and someone please tell me if this is available in other tools. The tools I've tried have a subset of these effects available for 'brushing on' but it's limited.