In-house support isn't too painful at the University of California at San Diego Medical Center, either, for some of the same reasons. All support is handled from within, and the IT group is headed by a practicing physician, Dr. Joshua Lee. The medical center really couldn't function any other way, Lee says. If nothing else, a doctor understands what doctors and nurses need in a way a third party never would.

But he admits his organization's framework is pretty rigid: Their laptops and desktops are standard builds, "and we religiously update and patch," he says. "We think that makes for the happiest users." As proof, he says, "No one has thrown a laptop at a patient -- yet."

If there are laptops being tossed around at the Manatee County Schools in Bradenton, Fla., where every child in the district has one, Tina Barrios, supervisor of instructional technology, isn't talking about it.

Keeping laptops close to home

She is eager to explain why she feels it so important to have support for the more than 10,000 laptops right in the school system. "We are better off understanding exactly what's going on in our own environment," she says. "There are a lot of benefits to us to offer repairs in-house."

International air freight company Atlas Air Inc. offers in-house repairs, too, though the users who need it are normally thousands of miles away in rural Asia, Europe or South America, says Long Le, IT supervisor in Purchase, N.Y.

Le says he would be open to hearing from an outside provider that could support laptops worldwide, and do it cost effectively. But for right now, he feels it's up to him and his team. Currently, at Atlas Air, all support is integrated -- desktops, laptops BlackBerries and cell phones -- through a central help desk.

But because his users travel so far, it can be tricky when the call comes in. "I tell them they can't expect a miracle, but we do our best to try and get them up and running," he says. "We know it's a huge hit to productivity if you get out there and your laptop isn't working."

It's a huge hit in productivity at giant railway Burlington Northern Santa Fe Railway, too, which is why the company decided several years ago to outsource all of its IT support, not just the laptop portion, to IBM Global Services. "With so many users [close to 40,000] and such a far-flung area to cover, it was mainly a financial decision to outsource all of our computing infrastructure," says Brad Hanson, consulting systems engineer.

The same situation is true at Applied Materials, where a companywide push toward greater mobility created close to 12,000 laptop users in short order. Applied Materials outsources the support through "badged" third-party employees who work in the company's various locations, says Matthew Archibald, senior director of global information security and risk management. "We outsourced with a set of standards and don't let people deviate," he says. "It's just so much more cost effective with this many machines."