It's not all Asterisk/TrixBox and SER/openSER, there's a whole world of developers out there who'd like you to be using their creations. One of the things that I really like about open-source software is that, generally speaking, it's been put together by enthusiasts, and that means people who are passionate about their product and don't mind working through the night to get a bug resolved or new feature added in.
The following list is the result of the last couple of hours I've spent trawling through a "VoIP" search on SourceForge. For that search, currently anyway, there's some 167 odd results. Last time I looked, back in 2001 or so, I seem to recall about 6 projects in total. Of course, many of these are pre-Alpha which means they exist in the imagination of some wannabe software guru only, with no code or anything at all downloadable or even written. Those are not present on this list. What I have compiled is a list of active projects which look interesting and/or novel or unique. Some of them may not even work, I haven't tested the majority of them, so as usual, downloader beware...
JOpenPhone
An opensource Java based User Agent application that allows users to connect to a voip servers using various voip protocols (including SIP and H323).
skype2rtc
A software ATA connecting Skype to an analog telephone line (the PSTN). Allows you to share your phone line with other Skype users.
Oreka
Modular and cross-platform system for recording and retrieval of audio streams. The project currently supports VoIP SIP, Cisco Skinny (aka SCCP), raw RTP and sound device based capture. Includes web based user interface.
SaRP
A simple SIP and RTP NAT friendly proxy written in PERL.
SIP Security Test Tool
A set of tools with which to check and manipulate SIP messages. There are also tools to run automated attacks, generating the the results as a report (use this one nicely please

). Some of these attacks use "fuzzing" technology apparently. I have no idea what fuzzing technology is, but I wonder if they mean "fuzzy"...?
MedQoS
Speech quality measurement tools.
NF_SRTP
A Linux only software package that provides RTP traffic protection based on SRTP, including confidentiality, replay protection and packet authentication.
WASTE dot NET
Waste.NET is a complete rewrite of the now defunct W.A.S.T.E. project. It aims to be a highly secure file sharing application, as well as a secure chat/VoIP platform. It's not SIP or IAX or open-standards based at all. And it's .NET/MONO. In fact, to be honest, I don't think it really has a lot going for it, but may provide some useful code snippets
NauPhone
An open source Call Center utilising H.323 or SIP. Some tools are included to help you get it integrated to existing CRM systems.
Cutlass
A C/C++ P2P application for secure chat, file transfer, and VoIP. It currently has GUI's for Linux/GTK+ and Windows/Win32. Apple's OSX/Cocoa is in the workds.
SIP Kernal Load Balancer
A set of Linux Kernel 2.6.x modules which do connection tracking, NAT handling and load balancing for SIP using the GNU libosip environment.
SIPSec
A secure SIP VoIP client using the security features from RFC3261 like S/MIME. A console application written in C++. It actually looks to me like it's been abandoned, but source is still available.
openPBX
Not actually on SourceForge, but a couple of our members seem enthusiastic about this Asterisk branch project, so probably worth a look. If one of you guys wants to come and explain why you think it's brilliant, please do so - that would be great (but start a new thread for it).
And for the sake of completeness, I thought I perhaps better not leave the big-hitters off this list:-
openSER
A full-featured industry-grade SIP server. We use it here.
Asterisk
The (by now must be) World famous open-source PBX.
TrixBox
The plug and play version of Asterisk, formerly known as Asterisk@Home, designed to turn that old rusting Pentium box in your garage into a brand new shiny PBX. Well, OK, maybe it won't be shiny. Or brand new. But it will be a PBX at least.
SIPfoundry
The land of the SIPxPBX and SIPx libraries and toolkits. Choc full of C and Java based widgets, modules, libraries and applications. Part of the former Pingtel suite.
And finally, for the Delphi users out there, here's a very useful little SIP based library you can go build a phone (or server for that matter) with:-
http://www.ictrnid.org.uk/index.html?softlib.html