I played console games most of my life so I like games to be between 20-30 fps, but things like aliasing etc... don't bother me. Have yet to have a computer that can run games like skyrim/oblivion/fallout 3 at high settings even without aa etc... So I balance it out by using the highest textures available (I rarely dl higher res ones) with lower settings elsewhere. for skyrim specifically, I set settings to medium then max out textures and view distances (except grass, depending on how many mods I have) and minimize shadows.
Tl;dr I like a balance of smoothish fps and high textures just for looks. other things idc like fog quality, shadows etc...