Some people quilt by hand.
Some quilt their quilts on their regular sewing machine. I've done a king size - NEVER AGAIN!!!
Some people have purchased rail systems to use with their regular sewing machine or mid-arm sewing machines.
Some people send their quilts to be quilted by someone with a longarm machine.
I have a long arm. Here's a link that will give you an idea of what one looks like. The second link lets you see one in action.
http://www.a1quiltingmachines.com/products.php
http://www.youtube.com/watch?v=bHma1...eature=related
I pieced tops for 10 years before I finally bit the bullet and bought my machine. DH said he was going to farm for another 20 years, so I decided it was time for a career change!