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If you have a Cummins, it almost makes your truck sound like a dump truck.
If you have a Ford, a 7.3 or a 6.0 will just make a lot of black smoke if you tune it right.
If you have a GM, you can make a lot of black smoke with a tuner.
If you have stacks, you are showing people that you think your truck is all big and powerful, just like the big rig tractors.
It's true that some people open up the intake and the exhaust, removing all the restrictions from the factory, stacks do this too, but a regular straight pipe also works.
I personally think they are obnoxious. They do what everyone else described. I think they look rediculous and have always wondered why someone would want to cut holes in the bed of their trucks.
I had a singly 5" Aussie style stack, position like this guys truck, I actually had a lot of people come up to me and say they usually hated stacks but thought mine looked good. Then I bought a slide in truck camper so out she came, put my stock exhaust back on but just modified the end to have a 4" pipe leading into a 5" tip, no noise anymore.