Today's Update:
OK, got the truck back last night. Here's the damage:
Harmonic balancer, belt tensioner, belt, oil change, diagnostics. Altogether, around $550 (parts and labor).
Also had lower front ball joints and state inspection done. Roughly another $450 (parts and labor).
Truck starts right up, no weird noises. Engine runs very smooth now, better than before I had this issue.
As a side note, a Ford dealer told me that I needed a harmonic balancer about 2 years ago (engine was vibrating, I changed plugs and wires, that didn't help). I brought it to this shop, and they told me they had never heard of that problem (engine vibration from harmonic balancer). Anyway, I've been running it that way ever since, never had a problem.
When I got it started the other night, I noticed the noise and saw the tensioner moving. I mentioned that to the shop, and they took a closer look, and said that the harmonic balancer looked like it was bad (wobbling or something like that while running).
I didn't offer up the harmonic balancer as the problem (forgot about it honestly), but now the engine seems to be running much more smoothly.
The real question is, could a bad harmonic balancer really cause the engine not to start???
Mike