Most monsters don't eat from the substrate nor live on it. They probably don't care about aesthetics either. Having said that, I like having a substrate.
It greatly depends on what fish you keep and what you personally like. Many fish like to dig, providing them substrate would be nice. Of course, they can survive without. So can lions in concrete cages with metal bars. Other fish of upper water regions do not need substrate, but are sometimes sensitive to reflections on a bare bottom. If you want rooted plants, substrate helps As stated above, it also serves as additional biofiltration.
I agree with you Shawn. I have also seen many pictures of tanks with no gravel or anything else in the tank. Just a bare tank! I would think the fish would get really bored of their surroundings. In my opinion I think one should make the tank as close to the fishes natural habitat as possible. I believe it makes the fish more settled and healthy.