This is probably one of the most commonly asked questions.  In general, we do what most hams do.  We work DX, rag-chew, participate in contests and have nets.  Just about anything that can be done on HF can be done on VHF+ within the limitations of propagation.

Some things are possible on frequencies above 50MHz which aren't generally possible on HF, such as bouncing signals off the moon and using satellites in orbit around the earth as amateur repeaters.  Both these modes allow international contacts to be made at frequencies which are normally limited to a few hundred miles.

Occasionally, frequencies above 50MHz "open up" and provide sporadic long-distance propagation.  At 50 MHz during Spring and summer, it is not uncommon to experience E-layer propagation out to about 1200 miles.  Once in a while, E-layer propagation is so good that "double-hop" propagation out to 2400 miles can be accomplished. E-layer propagation has been documented at frequencies as high as 222MHz. Other modes of propagation which greatly extend the normal distance of VHF+ communication occur as well. Normal 144MHz (2 meter band) propagation, for example, is limited to about 500 miles between two well-equipped stations. During "band openings" not involving the ionosphere, 2M propagation can extend out to 1200 miles or more. These band openings are the result of unusual but not-uncommon propagation modes which include troposhperic bending, atmospheric ducting, auroral reflection, troposhperic scatter, "knife-edge diffraction" over mountains, meteor scatter and, at frequencies above 5650 MHz, signal scatter off of rain and even snow.

The challenges presented by limitations and variations in VHF+ propagation present a special and exciting challenge to VHF+ operators. This is one of the reasons groups like "VHF South" exist!