They are messing this up in Windows 8, as every time you install a application, including desktop applications, all of its start menu items get pinned onto the start screen. I'm afraid most users will never bother to unpin them.
So now, I create a bunch of category folders (Work, Development, Entertainment, you get the idea) in the Start Menu profile folder (rather than the Start Menu\Programs folder), and copy the handful of app and applet shortcuts that I actually need in. I leave the All Programs menu to fester and ignore it. With Classic Shell, this works well; the classic start menu, in XP mode, shows my folders as top-level expanding menu items.