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Vista Print and Office Depot don't have Quality Score of 10 for all of their keywords...but I imagine they have QS 7-10 for tons of keywords.  They have a huge budget to test things with, many PPC tools (marin, hubspot, mongoose, analytics, omniture, etc) and a team of PPC managers/designers/programmers who have been optimizing their campaigns for years.  They also have a high CTR because of their brand name recognition, which raises their QS.  However you can compete and win!!  You just need to pick your battles.  What are your advantages over Vista and Office Depot?  Higher quality, faster turnaround, local service?  Focus on the areas you beat the big players.  Do you get a lot of business from local companies?  Create campaigns focused on local geography.  If your business is well known in your hometown, Office Max/Vista print don't have an advantage. QS is the most important long term metric, which is primarily based on CTR.  Create compelling text ads that get people to click them.  Use as many extensions as you can.... site-link, phone extension, location extension, social extension, etc....these all help increase CTR & QS.  When I am trying to increase QS, I only use exact, phrase & broad modified match type...no broad match type.  This will generate more targeted keyword traffic and increase CTR and conversions.  I also use dynamic keyword insertion, which increases CTR & QS.  Also remember that QS is a long term metric, so if you increase your CTR today, you QS will increase in a few weeks/months.