Verizon local service would cost about $21/month in this area + added long distance charges.
I enjoyed good savings with broadvoice.com for a time, for $22.09/mo, which included flat-rate long distance at no extra charge.
When area775.com started, I was quickly a subscriber as they had numbers local to Northern Nevada, and my I estimated that their extremely low metered usage fees would be about $11/mo. Which was true until I found Skype.
Skype offered an extremely low flat rate to US and Canada starting in 2007. I've been using them for outgoing calls ever since. And their service even works better than area775 or broadvoice. Unfortunately, they don't offer local numbers here in Northern Nevada, so I kept area775 for incoming calls.
The quality of area775.com seems to suffer when there is limited bandwidth available, so when I switched from cable to fixed wireless, it was hard to receive calls successfully. And area775.com never did fix the bugs that prevented hardware ATAs to work with their service, so we had to use the Gizmo softphone... a nice softphone, but annoying to not use the regular telephones.
By now, there are a number of providers with local numbers in Northern Nevada, but by no means all of them. Broadvoice has local numbers now, but I like lower prices now. I found voipvoip.com will give incoming calls for $6.99/mo. That is higher than area775.com, but the service works better on fixed wireless. So I'm at an effective $10/mo flat rate now, $7 to voipvoip.com for incoming, and $3 to Skype for outgoing calls.
Update August 2009: voipvoip.com started being unable to connect incoming calls some months ago, but they did transfer to voice mail, which worked. Because I was busy, this sad state of affairs hung on for several months. I finally reported it to them, and they fixed it, but in the process disrupted my voice mail for several days, which annoyed me, especially because they didn't tell me in advance that would happen, even though I had informed them that their voice mail was the only way people were able to communicate with me by phone.
About the same time, Google responded to my request for their Google Voice service, that I had almost forgotten making. However, they have free local Gardnerville numbers, and will ring both cell phones, as well as a lashup with the free Gizmo sip service, which works fine on my Grandstream box. So I'm dropping voipvoip.com and its $7/mo charge, and am down to $3/mo for outgoing Skype, as my total telephone-specific expenditures. I've also dropped the fixed wireless solution, and finally (that is a huge story) gotten the slowest, cheapest tier of service of Verizon DSL, and it works well. Of course, by the end of the year, Verizon is supposed to sell their services in this state to Frontier.
The remaining challenge will be to convince Skype to use my Google Voice number as its caller id when I make outgoing calls. There is no reason this couldn't work, but Skype's current method for activating a caller id number (text messages to that number) didn't work for Google Voice, even though Google Voice will accept text messages (theoretically).
Update November 2013: Google Voice has been working wonderfully for the last couple years. They bought and eliminated the Gizmo service, though, and so I had to switch to a different provider for incoming VoIP calls... and because Google Voice will only forward to phones with numbers, not SIP URIs, it had to be a service that offered numbers. I used sipgate for most of the last couple years, and then they terminated service with a month's warning. Then I signed up for ipkall for a number and callcentric for a VoIP with a SIP URI. Ipkall only has phone numbers in WA, but with Google Voice in front, that is no problem. Back when I signed up with sipgate, it was hard to get an ipkall number that someone hadn't already used with Google Voice, but last month it was no problem to do so. And callcentric works fine with my Grandstream VoIP modem, so I can continue using my wired telephones instead of a softphone.
With Google Voice, I can use it to establish outgoing calls (from a computer) instead of using and paying for Skype. So my total monthly landline telephone bill has dropped to $0 for the last couple years. I'm still looking for a way to reduce it!