Larry Osterman answers the question, why do I need such a large page file?
An aside to this is, why does Windows seem to be constantly swapping out? The answer lies in the working set. Windows tries to keep a certain amount of physical memory free in order to allow memory allocations to succeed - in other words, it uses a bit of otherwise-idle time to clean up memory not used recently so that programs don't have to wait as much when they need more memory. It also tries to share out the amount of memory fairly. The downside is that, if your process's memory usage profile is poor, the system trims off a piece of your process's memory that you haven't used in a while - then you immediately reference it. This can happen if you have a large disorganised data structure that you scan oddly, or parts of your program code that are related are a long distance apart.
I thought I was being bitten by this in our server application recently, and tried using SetProcessWorkingSetSize to give us a bit more size. However, it had no effect. I surmise that what was in fact happening was that the Windows message queue (this server uses the Winsock control for incoming data) was growing, and growing, because the server wasn't keeping up. This seemed to be causing a lot of swapping, which led the server to get slower, and slower, causing more and more swapping. It wasn't a memory leak, as such, because the process's working set dropped right back down again as soon as the load was removed.