There are plenty of services out there offering to set up and maintain your account, Nothing wrong with that, I do that too. (more than 150 companies now with a combined $300K in clicks per month) A common scenario for a small to medium business may be, once the sales person leaves you there is a kid 18-20 years old on $18/hr for a couple of days per week who sets up accounts in a very basic way and sends you a report every now and then to keep you happy. What happens when they leave? I've seen this 1st hand. A start-up search engine marketing company asked me recently to train new staff, after 3 hours sitting with me, they are now the "AdWords Experts" for this particular company.