In looking at all the options for our rescue truck (including suggestions made in this thread,) we opted to go with the full-on front hitch receiver. It was not that difficult to install. Minor trimming of the air damper was required. On the 2500 I did have to drill and tap two holes (one on each side) of the frame to install the recommended "third bolt."
The front receiver has two tow eyes mounted below the bumper so there should be no damage there, and as previously stated, the structure provides really solid frame attachment, strength and stability. We also went with a 10,000 Lb. "Speed Mount" winch that would fit into the front receiver. We went with the Champion winch since it would fit in our storage space.
So here's the deal about a winch. We respond in sand and snow and, well, it's not uncommon for us to have to winch free and even use multiple vehicles as anchor points. As a result I recommend carrying a speed mount winch if you have the storage space. But here are the limitations.
The winch needs to be facing either the anchor point (if the winch is on the vehicle being extricated) or the load (if the winch is on the anchor vehicle) pretty much straight on. Otherwise the wire rope will pile up on one side of the drum and the whole business can jam. So we also made up an extension cable. The speed mount winch can be attached to any 2" receiver and the cable run up to the battery of the vehicle that will be doing the winching. Thus the winch can be positioned to give the most straight pull. If we can use a winching vehicle that also has a front receiver, this whole business gets really easy.
Here is an info sheet on our setup on the 1999 Ram 2500 that illustrates the various options to help anyone reading this thread decide on the most appropriate approach for their needs.
http://www.whmentors.org/evac/winch_pro02.html