I've had some friends use 99Designs...I can tell you that even though you are paying more, the quality of work that comes from those designers affiliated with that site is superb. For those Twitter backgrounds though, I can't imagine paying a couple of hundred dollars for a customized Twitter background. I mean, unless that comes with the design of a customized logo for branding purposes.
The concept is sound. You describe your project. You specify the price that you're willing to pay. Then multiple designers compete for the money. You pick the winning design. Prices are less than hiring a professional design firm directly. You can get a template for $600 to $1000 instead of $5000-$10000. There are competitors to 99Designs out there though. So you might shop around. Check current and past contests. If you can contact past contest holders to see if they would shop there again.
I've tried a few contests there, usually for logo work. Sadly, it gets hard picking out all the people there that use stock images and just through in some fancy font.
Thanks for the feedback. Does anyone know any competitors to 99designs? I found a site the other day and thought I had bookmarked it...apparently I didn't. EDIT: I think it was based out of the UK, if that helps.
You have sites like eLance.com and Freelance.com. A direct competitor to 99 Designs would be a site like Design Outpost - Graphic Design Firm - Logos, Templates, Print Material, and More. I've had work done at designoutpost.com but that was years ago when a web layout went for $200.00. Not sure what they are going for these days there. As far as vBulletin specific, you can get a PSD layout done at one of these places and then pay someone like psdtovb.com to convert it into a vBulletin style.