Doesn't have to be ghetto tho. And it can work better than even the 'best' of the stock coolers. Most gpu fans have weak static pressure and low air flow numbers compared to decent 25mm thick fans of the same size.
Had a Giga 280x OC - its fans were failing and would hit 80+c on load. The vrm temps would be great for a not-so-slow cooker, 90+c. Removed the useless faux shroud. Removed and cleaned the cooler and gpu hsf. Replaced the gpu TIM with Kryonaut and replaced the vrm pads with FujiPoly.
Created a custom mount for 3x 2500rpm 92mm Scythe S-flex fans so the fans were contacting the heatsink, but their weight carried by the mount connected to the case, reducing card sag.
Resulting temps at load were 58-60c gpu and 76c vrm. And far quieter at any load than stock coolers I've used.
System had a green theme even tho it was powered by team red. ;-)