I am in a unique position to answer this question. My development office is in Delhi, India, while I am local stateside. I work directly with clients here, on their requirements and vision and with my developers who furnish the final product. I focus on building relationships because there is no other way I want to work. I agree a 100% that there is a price difference, and I work hard to get the quality my clients require and want both in terms of development and front end. I also agree with most of you that programming and development is more affordable abroad.

Hiring good branding and marketing personnel in India could be a frustrating, but not with the right connections. A lot of you mentioned the difficulty in communication that hiring from India can present, but with a project manager in the U.S. that problem is mitigated. I usually meet my local clients in person and make sure their vision is pre-approved and 'alignable' with their values and budget.