Lower geared (higher numerical ratio) differentials will allow a relatively small and low power engine to start and pull extremely heavy loads. It can be done at the expense of poor fuel mileage, lost top speed, high rpm at low speeds, and intolerable cab noise as others have already stated.
Big trucks with multiple speed transmissions can overcome the drawbacks.
Edit: After writing the above it occurred to me that a better answer can be offered in two words . . . torque multiplication.