How many of you have alts that you actively play on multiple servers?
How do you do it?
Right now, I have what I guess you’d consider two "mains:" my DK on Kael’thas, temporarily a human (seriously, the only redeeming feature of the entire race is the reputation boost), and my warlock on Feathermoon, who is now an orc under a different main. I also have a smattering of other alts here and there – a draenei shaman, a dwarf rogue, a human priest who I regret transferring, a gnome mage, a gnome warrior who I also regret transferring, and a dwarf paladin on Kael’thas, a blood elf hunter on Feathermoon, DKs scattered across different servers, and so on and so forth.
Each of the ones who’s actively played also has other people associated with it, and various… well, "responsibilities" is as good a good word as anything for it. My death knight is "responsible" for going insane right now. My warlock, I’m determined to get him to 80 before Cataclysm, but Cataclysm is virtually upon us and my warlock mojo comes and goes, plus he’s supposed to at least be chatting with the lovely Anarkali, so I guess that’s his "responsibility." My blood elf hunter is still in my old Horde guild on Feathermoon, unless they booted her anyway (the armory doesn’t say so, but it’s been a while since I logged into her). There’s another "responsibility:" I left them suddenly like a thief in the night, which wasn’t really fair to them. Especially since they weren’t the ones I was getting away from.
And then there’s my usual alt-itis. I’ve recently had the itch to roll a druid, despite all the other things I quote-unquote "need" to do in game. My shaman is making puppy eyes and asking to be leveled, and saying hey, maybe you’d like to go back to trying enhancement? And I’m pretty sure my warrior is going to get nuked and rerolled when Cataclysm rolls around, as will my hunter; I’ll need some worgen and goblin classes to level, after all.
I’m just really bad at making balances, I think. And there are many people on each server I have an alt on who’ve basically been asking "where are you?" so I feel guilty for spending time on one server or another. I think I’m starting to realize why I used to keep all my alt-eggs in one server-basket, and sometimes I just want to commit WoW amnesty: just start a new alt on a new server and just start all over. Sometimes I seriously think about mailing all my heirlooms and gold to a single toon and just nuking everyone and starting all over. (sheesh, I sound like Brigwyn and his alt deletions).
What advice do those of you who maintain multiple alts across multiple realms have for me?
Wow, this sounds just like me
Toons I transferred/faction changed that I wish I hadn't, and altitis out the wazoo!! Only saving grace is that I am now working on getting everyone onto one server because my Alliance guild decided to treat my brother horribly, so it's back to the Horde for me 
When running toons on multiple severs, I usually will play one to a certain milestone, such as getting to 70 or some piece of gear I am working towards, and then I will switch to the other. Unless I am not in the mood to switch then 
I have to have a list of what I need to do on every toon. Twinking helps — pick a level bracket to work on, then gear / skill up each alt superbly for that bracket. It gives you a chance to "finish" working on an alt and makes defining your goals easier.
I had my Alliance main and my horde main, on separate servers, for a good 5 months or so before I ended up with the bulk of my time horde-side. For me, the way I managed it is I divvied up my play time with raid nights/days for each one that I stuck to, and I tried on non-raid nights to log in to do dailies and say hi to folks at least for a bit.
I condensed to two servers: one Horde and one Alliance. I switch back and forth pretty easily but sometimes get a little bored with one side, I can go to the other. Makes it easy.
Cross me off your "responsibility" list – I won't be responsible for guilt, however small, regarding your playing! Guilt ruins everything – I know
As you also know, I struggle with your same "omgtoomanycharsandservers!" issue. So… can't help you there, unfortunately >.>
IMO? Stick to the big "main" goal – insanity!
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For me, I guess I'm a bit selfish. I just play who I want to play when I want to play them. If people say, hey, where have you been? "Sorry, had a bout with alt-itis" seems to work just fine. Most of my main alts are on the same server and even in the same guild, so it's not as bad as it could be, I suppose.
The way I see it is kind of cliche, but it works for me. This is a game. If I'm going to spend my play time feeling bad because I'm not doing what other people think I should be doing or want me to do, why play at all?