You buy rack space, they give you a network cable and IP details. You configure the OS with that IP and your online.
This is purely my opinion, but I think that 1) there is a strange shortage of IT professionals (people who are not software engineers but instead understand systems) in much of the industry today, and 2) a lot of tech companies, even those that are currently well functioning, might be able to save a lot of money if they hired someone with a conventional IT background. This is a little self-serving of course, but it really does astound me when I see the bills that some companies are paying cloud services to do something that is traditionally done in-house by an IT department. And not everything can readily be outsourced to some "aaS" provider, so on top of that you end up with things like software companies with multi-million budgets running an office network that consists of a consumer WiFi router someone picked up at Fry's - not realizing that they are losing a lot of time to dealing with how poorly that ends up working.
I think part of the problem rests in academia - at least in my area a lot of universities seem to have really backed off on IT programs in favor of CS. I went through an undergraduate program that involved project management, decision analysis, and finance courses because these were considered by the college (I would say accurately) critical skills for the IT field. But that program had an incredible two students and was widely considered inferior to the CS program with hundreds.
Another part of the problem though seems to rest in industry. The salary differential between "DevOps Engineer" and "IT Analyst" is incredible when in practice they end up doing mostly the same thing in a lot of small orgs. So I end up walking sort of an odd line of "I have a long background in IaC but I also know about conference room equipment." And I'm not saying that everything with a Cisco/Tandberg badge isn't overpriced, but Zoom rooms can end up costing just as much and seem to be less reliable - not surprising for a platform which, by practical necessity of the lack of IT support in many orgs, is built on the Silicon Valley time-tested architecture of "five apple consumer products taped together."
It's usually done with the "let's pretend it is ITIL" process.
Let me give two examples where if I had been the client then I would absolutely have sprinted for the cloud if I could, or at the very least start talking it up as much better.
1) System outage, time to fix 5 hours and 3 minutes. The 5 hours was me sitting in front of my computer with screens open showing the problem and waiting for various managers/decision-makers to fly by and take a look as they were ping-ponging around the office panicking about what would be impacted by the fix. Everything that was going to get impacted was already impacted by the system not working, and I had to explain that to them multiple times. Towards the end of the day, I eventually got the go-ahead to do the 3 minutes of work to fix the system. This system being down had prevented another team from doing any work for the entire afternoon.
2) Two full days of politics and paperwork to get approval to do 30 minutes of work, all while the client was impatiently asking "is it done yet" every few hours.
I have a good experience with [1] (a smaller local company) and Hetzner [2], a bigger provider. Compare the prices with cloud. Especially if you need something RAM intensive.
This is actually the main one for me. I've managed our own servers for a decade with almost zero downtime, and very little time spent at the colo. But you cannot safely go out of town without having someone else around who is familiar enough with your setup to deal with an outage.
So moving stuff to AWS now almost entirely for that reason.
It's really not that hard.
We have a bunch of hardware coming up on end of life. I looked at moving us to cloud. The new hardware will cost about what 3 years of AWS would cost. Considering that the hardware I am replacing is over 6 years old, we are better off sticking with on-prem.
That's not enough time to keep OS or software up to date, or to monitor hardware usage, or to replace failing hardware and deal with spare parts.
I help manage ~50 on prem servers plus NAS, switches, etc. Over the past three years, I have had to replace one hard drive and one power supply. And neither of those brought anything down because of redundancy. We get alerts when something goes wrong, but that is a rare occurrence.
This is my original point: servers won't just explode the minute you look away. It is not a full time job to "manage" them, unless you are at a real datacenter scale where a 1/1000 event happens twice a day. You set them up and then they continue to do what they do for a very long time.