I have ran into this problem a few times and I am wondering what other people are doing.
When I am creating a database, sometimes I have to import data into a table
Well, when you do the import, import into a temp table, and then update the records in the production table (update in the generic sense of the word: delete what's deleted, add what's new, modify what's changed).
You might also want to check out the new MERGE
SQL command in 2008, it just might turn out to be very helpful for this case.