It works great, once you get the bugs worked out. I suggest you get a test system of your choice set up and start playing with SIP trunks. You'll quickly learn to hate it, then eventually love it.
Most providers do require 10-digit dialing, which means long-distance is dialed just like a local call will be. Once you set up LCR on your switch, it is not a big deal. One way audio is typically a routing issue. I haven't had enough experieince with echo problems to give an opinion on that.
My advice is start with the phone system you want to sell, then come up with a router that works well with SIP, and keep selling the same two products. Remember, QOS is your friend. Good luck!