Take a look at the back of this Shuttle PC...
http://images.sudhian.com/review/sff/shuttle/sb75g2/Figure_4a.jpg
... If the grill/case was cut away from where the fan blows out, wouldn't
that make a BIG difference to cooling and quieting the computer?
Yes, that will help a LOT, but there are some other considerations
that go along with the idea.
If you were to reduce the fan RPM so air movement remains constant,
you'd reduce noise but not cooling to any major extent, but that would
better preserve the present airflow design. The more air you move out
that fan (hole), the less you'll be moving through the power supply,
which may be as likely to fail from heat as the rest of the system. I
would expect significantly less air though the power supply if you cut
that out. Those power supplies with tiny fans don't move a lot of
air to begin with so it's good to preserve as much of that airflow as
possible.
I'm not suggesting that you not modify it, but to also look at ways to
increase airflow efficiency though the power supply. Cutting out the
power supply's rear grill may not be enough, you might need to alter
it's intake, but again taking care to keep the airflow pattern
similar, not diverting air away from the path it was designed to
follow.
With all of the above, futher gains will be see from increasing air
intake passageways, but again looking at where, how it affects airflow
distribution. Airflow over the motherboard's power regulation region
should not be reduced, nor around the hard drive.
Dave