We switched to netTALK several months ago and our results have been mixed. We cannot afford a monthly fee so we're sticking with it, but we are not 100% thrilled. Maybe 75%. The sound quality is iffy; depends on the call. Sometimes calls do not complete and we have to call people back. Caller ID does not work as it is supposed to, and the voice mail is just awful. I do have a workaround for voice mail using our Google Voice account: I have the netTALK number set to ring our house phone first, and if nobody picks up, rather than going to voice mail, it rings our Google Voice number, which is currently set to go straight to voice mail. so effectively you get 4-5 rings, then voice mail, which is as it should be, in my opinion. netTALK's voice mail is not customizable. You get the default greeting no matter what you program in. It is improved from when we first signed up; it used to say something like "the number you called is unavailable." Now it says "The netTALK subscriber you have dialed is unavailable," or something. So at least it doesn't sound like a dead number. Google Voice voice mail is fully customizable.
We did have to tweak the router settings some so that the port that the netTALK is on bypasses the firewall. That improved the voice quality by quite a bit. Sometimes it's excellent. More often than not, though, it's frustrating.
The short version: A lot of downsides, but we're willing to put up with them because it's so cheap. Were we in a different financial situation, we might not be.