BTC LTC and the Alts will become investment vehicles where liquidity is not as important before they are used as currencies. Consequently exchanges etc. are not as important as one would assume. You just need some ability to trade your coins for fiat, you don't need some super efficient forex.
I agree with you, this will take some time though especially for the young alts. Actually i think a decentralised community meeting point is probably the largest thing lacking right now. This forum is awesome but they need a back up plan that we are made aware of now.
Coins to fiat would have to be through a kind of local bitcoin kind of scenario, i guess there is no other way.