Great question. Basically, it depends on what your intended use. Generally a small license fee opens up use for most commercial work (advertising, corporate video, websites), with some limitations on the number of times a stock image can be reproduced (istockphoto.com’s standard license is under 500,000 uses). Items for resale, like taking a stock image - unaltered - and putting it on a t-shirt, require a larger license fee.
For creative or artistic purposes, things get a little murky thanks to the introduction of something called derivative works. A derivative work is something based on one or more pre-existing works (i.e. translations, art reproductions, etc.). Generally, if a derivative work shows some originality of its own, it becomes a new work, protected by its own copyright. So if I take a bunch of stock images, printed, cut them out, and glued them together in a collage, that would be a “new work”, and as the copyright holder of this new work, could sell it to my heart’s content. If I take a stock image, print it out, and glue it to a tile I have not transformed the original enough, so this would be the same as the t-shirt example above.
There is also something called fair-use that allows for the re-use of copyrighted material without credit or licensing. If you are interested about it you can read more here.
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Hope that helps, and if you have other questions, feel free to ask.