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What issues do you run into and how do you deal with them?
Example: When presented with 5 things to do, along with costs, that all need to be done, they ask you to prioritize by importance and only approve doing that one (most important) thing (because they don't want to spend any more $). This approach obviously won't yield the results they want & yet they won't understand when it doesn't.
(yes I am currently patiently educating one of these)
IMHO, the only thing that they don't seem to understand is that the search engines are not supposed to work as they think they should.
Also sometimes, they are too impatient and expect results overnite - which obviously doesn't happen.
Best way is to clarify such issues with a customer prior to signing the SEO contract
Take for example the UK credit card market. Provider Y has the lowest interest rates, and will accept 90% of the population, yet when someone searches for credit cards, they will still want to see one of the aggregation sites that we have, because that is how people shop for credit cards, and those companies have 4X the budget of any individual credit card company, they can push out more off line advertising and will always receive the lions share.
It is very important that companies realise that just because they are online, doesn't mean they should be at number one. I always put this in terms of offline media which people understand. If you are a small business you wouldn't expect to have the same amount of TV or national newspaper advertising as the large multi national operating in your sector. Online business in many ways is no different, and so the expectations need to be adjusted.
This has always been the biggest reason for SEO to fail imo, it's not that it fails but that the expectation for success is too high.