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I have been working with 2 monitors for years.
This week I upgraded to 3 and after tomorrow will be using 4 (when I pick up a long enough DVI cable to reach)

Already with 3 I have found some productivity gains.
I have 2 22" widescreens as my main monitors and 2 19" widescreens either side of them. As my desk is a curved reception desk (curves through 90 degrees) they sit very nicely on it.
So how did I make it work? Well two BFGTech 8800GTX OC 768Mb video cards (SLI) help - and a massive server case fan to cool them!
I have the 2 19"s either side of the main 22" monitors. So from left to right they are numbers 3, 1, 2, 4