Version 2 of the desktop Othermill milling machine is now available, and it’s accurate enough for a range of machining tasks, including double-sided PCBs.
The machine can handle a range of materials, like brass, aluminum, wood, and plastic. For PCBs, FR-1 is recommended over FR-4. With a small milling bit, footprints as fine as TSSOP & TQFP can be created. Solder paste stencils can also be cut using the mill.
For a good walkthrough of PCB creation, read this blog by Tom Simon, a user who liked the Othermill so much he joined the sales team.
For more detail: Desktop milling machine creates PCBs and packaging