I use a modified Zenbot CNC with Kester R276 paste and a shot dispenser run by CNC controller. Simple, very flexible and no NRE for screens.
Another big item for me is practically zero waste on solder paste & no cleanup associated with paste masks. Yes, it is slower than a screen, but way more flexible. I have about 30 different board types I make in small batches, so the flexibility is really important.
I do mostly 0805 / 1206 & SOIC so the shot dispenser variance is not a big issue, especially with R276. I do have to adjust air pressure a bit depending on room temperature, but that is minor.