First you have to decide what you will be doing in the room.
THEN you select the appropriate lighting for the tasks.

Not all rooms need a "large central fixture of some sort"....

I'd say the first questions are, How big is the room? and What do you plan to do in the room?

We are planning a modest-sized great room, and these are my thoughts on lighting. I'm not saying they're brilliant, but they're pretty basic and are in line with your thoughts.

- One large ceiling fan with light kit in the middle of the room. This'll be for general illumination; that is, any evening when we just want to "knock off the dark" but don't particularly need a great deal of light. I'd see this as something we'd use in the evening while we're working in the adjacent more-brightly-lit kitchen. Maybe this is for times when you aren't actively using the room, but you also don't want it to feel like a dark hole. It'd allow you to walk through the room without fear of bumping your knee, but you probably couldn't sit down and read a book.

- Recessed canned lights for times when we need general illumination at a brighter scale. I'm thinking this is for times when perhaps you have people over, and you want general illumination PLUS you don't want the corners to feel dark. This is for times when you don't need to see things in great detail (i.e., you're not reading or doing a craft).

- Lamps by the sofa and chairs for reading, needlework, or other "need light activities". This light is focused, bright light that'd be used by a person sitting in one particular spot. I'd see this used in conjunction with the overhead ceiling fan light.

- Sconces on the wall for soft-light; for example, to have a little bit of light while watching TV. I'd place a couple of these around the room -- I'm thinking two flanking the fireplace and two (on opposite sides of the room) at the back of the room. These wouldn't create a bright light /a glare on the TV. These might be left on if we had guests who weren't familiar with the layout of the house and might want a little bit of light to find the kitchen in the dark. These would be low-light bulbs.

- A "shine down" light of some type above the fireplace (perhaps this is another canned light?) because we always seem to want to illuminate that area.

Thanks for your input. As MrsPete mentioned, I'm thinking the central fixture would be for general, overall lighting. We will have task lighting where needed. I think a central fixture also looks nice. The room is 20 x 20; we may expand to 22x20.

Is anyone willing to share what they've decided to go with?

Our great room is about 24x24. We have 1 central 15 light fixture and 2 wall sconces. Otherwise, we will be using floor lamps etc for lighting.

I like recessed lighting for task lighting (ex. kitchen) but did not want it on the vaulted ceiling of our great room.