When you see a messy counter in a movie, you can be sure that that mess was deliberately made by a production designer.
Production designers make the sets look good, but there’s more to it than just being able to decorate. There’s a lot to know about what looks good on camera, what looks terrible on camera, and how to position things so that there is artistic balance and attractive nuance on screen.
I don’t use them all the time. In the rush to get short projects done, this is often one of the jobs that are eliminated if I don’t have time to look for one.
But when I do have a production designer, my shots (as a director) look better. More balanced. More interesting to the audience’s eye.
Production designers also create special items for the set (called set pieces) that are necessary for the script, like a box that has a special design painted on it (although sometimes the props department and set designer work together on items like this.)
When you go into public locations where you really can’t change much around, there is really no reason to have a set designer. I shot in a bar where I knew we wouldn’t be changing anything in the room except to move a few tables around. So I skipped the set designer.
I was on another set, however, where the DP kept moving set objects on a “hot set” (a set that has already been captured in previous shots and so should be kept the way it is in those shots for continuity purposes) and the set designer was getting really frustrated having to follow around the DP in order to put things back the way they were.