I hand-route everything, because I can't buy an autorouter I trust. I did see one once. It was in a development lab of a former employer of mine, a Fortune 100 communications company. A friend let me run a few boards on it to see how I liked it.
It was amazing.
Completely, unbelievably perfect. It placed the connectors where I told it to, and carefully routed the lines in the order of importance I assigned (as well as ordering a number I didn't bother with, since I planned to route them myself when it was done), and it didn't violate any rules (including the ones I've made up over the years and didn't tell it) of PCB design. It placed the vias and layers and components so well I'd swear it was human. It also game me an EMC map of the circuit, and showed me why it did what it did. It took into account the field around a current sensing trace and kept it away from a critical resistor trace, but by only enough so that they wouldn't interfere, which was closet than I ever would have guessed. It managed the chip layout such that the heat was perfectly distributed under normal operating conditions, and it kept the crititcal traces short, fat, straight, and impedence controlled. The thermal map was a thing of beauty.
It did everything that my normal board design guy did, but faster, tighter, and without 3 pots of coffee. The board it spun was an incredibly complex RF test vehicle, which included 3xTX, 3xRX, triplexing, band conversion, DDS, several codecs, a microwave section, 3(4?) DSPs, and enough passives to bury a knob in SMT bits. Did I mention the embedded PCB features? We had inductors and caps in the copper too. It distilled 100 years of layout experience, and from what I understand, the collective expertise of no less than 50 of the top PCB engineers available at the time (1997), into a command line program that sucked in a netlist and spit out gerbers and modeling data and pretty pictures the a matter of an hour, running on a lowly SuperSparc20.
It also cost about $250M to develop and was for internal use only, since it was really designed to lay out wafers, not PCBs (tho I hear the requirements for wafers are similar once you abstract the basic features into blocks like ICs, at least in theory). I stopped counting the number of patents it garnered at 40.
After that, I never saw another autorouter/autoplacer I liked. Ever.
And finding one I trust to lay out a board for me? Forget it.
So yeah, I hand route everything.
-dave