In the end I went with a fanless MSI FX5200 TD128 Quiet Video Card. It may be a P.O.S., I have no idea, but I figured that in any case it's probably better than my current card, which I have no problem with. At $70 it's no big deal if I don't like it. I also got a Zalman CNPS9500 fan/heatsink.

After poking around I noticed that my current heat sink's mount bracket is loose on one side, so the heatsink only contacts about 1/2 the cpu (even with grease).

The Zalman and the new video card should quiet this thing right down. I already had a quiet power supply from PC Power and Cooling.

Here's hoping!

-Zeke