Hi Jon,
Not long ago, with raster tiles and Tilemill, generating MBTiles files had a similar feel to desktop publishing in the 90s/00s. Working with vector tiles and Mapbox Studio feels similar but Mapbox hosts the tiles, making it unsuitable for some applications. Generating your own can be straightforward or very complicated and rendering times for a deep range of zoom levels can be prohibitive for individuals working on a desktop. I've had beefy AWS servers running for days, even weeks, to render tile pyramids.
Verify this on your own, but Andy Allan in the UK comes to mind as a clever cartographer with vector tile generation in his revenue stream. Colorado cartographer Gretchen Peterson certainly does a lot of design work in this area although I'm not sure she herself generates tile bundles; quite possible, it's been a few years since we've collaborated.
I've done this for paying clients and also for my own experimental film/real-time cartography work, partly because I can inject data for my own purposes and partly because I want to reduce tile latency as much as possible and self-hosting gets you that.
Eric