A 4th axis on a mill is typically used to perform rotary milling - like milling a helix for example. It's a handy thing to have to make nifty stuff and for some parts it is required - such as a shifting spool for a transmission.
I am sure we can scrape up some fine examples of stuff you can make with a fourth axis that would be very difficult or impossible by any other means.
And yes - five and six axis machines are common. Finding a truly competent programmer for them can be a nightmare.
Scott
Consistency is a good thing....unless you're consistently an idiot.