They pitch Azure Update Manager as alternative, but depending on the scenario (especially with on premises machines) it can cost up to $5 per machine per month.
Microsoft unofficially deprecated wsus a long time ago. Out of the box it can't even serve modern clients, what started as "just make these changes to iis until this is fixed in a patch" became "we aren't really interested in new wsus versions". I'm glad it's become official .
I know of many institutions that rely on wsus as a way of locking down external traffic from sensitive areas on the corporate network. Granting these machines internet access is often undesirable.
I'm not sure what you mean by modern clients, but we have numerous WinServer 2022 connecting to our internal wsus servers.