The GPS route planner @ http://www.marengo-ltd.com/
I've been transferring my MAD maps paper map into Garmin RoadTrip (MapSource for the Mac) routes. The marengo thing is a google maps based route planner.. you drop pins on a map, and it exports the route in GPX format, which is then imported into the Garmin software.
Seems like a lot of trouble, but I think the google maps interface and maps are 1000% better then the maps in RoadTrip. You can actually find places and roads.
Once the basic route is imported into RoadTrip, you then tune the route to remove u-turns and what not.
I'm sort of a noob when it comes to this GPS stuff. I think that mapsource is probably better than roadtrip, but I don't have ready access to a windows machine. So the combination of a google maps based solution to find places, and then tuning the final route in Garmin seems to work.
My 2C.. The marengo thing is free for a month.