The video card has a built-in fan, but you'll still need a powerful outake fan.
I might be a tad crazy, but my box has an intake at the front. A GPU fan, a mobo fan, an intake inside the box that pushes the hot air into the power/fan unit, and an outake at the back of the power/fan unit. Plus as DVD-RW/ROM fan.
EDIT: Also forgot that I have an intake in the back as well.![]()