IMO now that I own a couple of pier and beam houses in Charleston, where the soil is much kinder towards houses than in TX...
They do need maintenance, in that maybe every 20 years or so it's a good idea for a crew to come in and level the place just to keep things where they're supposed to be. The extra 40 years between the two houses REALLY shows. The older of the two may never go back to like new condition, but I'm definitely farming out leveling the place so doors and windows open/close properly, and leveling the one we live in so it doesn't get that way.
So I guess that's the drawback... periodic maintenance, plus the fact that critters can get under the house if the opportunity arises and people tend to walk more loudly. Especially a certain 100lb wife who walks on her heels. IMO insulation is dictated by where you live. A conditioned crawl (no ventilation / insulation around the brick perimeter / HEAVY tarp on the ground and sealed) is best. I've seen fiberglass trap moisture, where warmer air from inside travels down into the cooler, humid crawlspace. Water condenses where the warmer air meets the cooler air from below the house at the bottom of the subfloor / top of the fiberglass.
But the benefits are huge. It's MUCH easier to move utilities, especially plumbing. I'd like to relocate two toilets, a couple of sinks and a shower plus everything in the kitchen. No big deal, because I don't have to jackhammer through concrete to get at the pipes. Moving outlets and adding a cable for our tv antenna was simple too.
IMO our foundation isn't strong enough... there's too much deflection for the type of flooring I want to use, and an idiot notched 5 joists in the middle. I'm adding 22 piers and five beams. It absolutely sucks, but if for some reason we had to have foundation work done on a house with a concrete slab it'd be an absolute nightmare to DIY, if at all possible. Likewise for our 1920s house downtown - I plan on raising it 3 feet or so to get above flood grade + 2.5 feet, which is loads easier than lifting a place on a slab.
edit:Just my opinion, but you can put all the stone and tile in if your deflection is good, and you have solid / enough piers to make sure that nothing is going to really go anywhere. We have tile in 5 rooms and none of it has cracked, except for where some idiot notched the joists and now the floor deflects too much. None of the houses I looked at with tile on a mud bed (1950-1980) had any cracks either. We're going with stone in our kitchen (15x33) and entry, but our unsupported joist span will be about 6 feet, and joists will either all be sistered or tripled. Can we say, overkill?
[This message has been edited by The Fife (edited 4/22/2012 8:44a).]