Is there an automatic path from a high poly model to a low poly model? Or do the tools just create approximations that have to be hand crafted for lower poly models?
This is actually a more complex question.
There are some quite advanced off-the-shelf tools available, that can decimate a super high res zbrush sculpt to more manageable polygon counts; and also some pretty advanced auto UV tools.
There are also apps to create textures with really finely controllable proceduralism, like Substance Designer.
One of the most interesting talks from last year's GDC was about implementing these tools into an asset production pipeline. The main point was to utilize them for rapid prototyping; you need to build a starting library of shaders, skeletons, parameter values and such, and you have to write some code (mostly scripts for the DCC apps and some exporters). Then you can take a work in progress zbrush sculpt and literally publish it into the engine as a fully textured and shaded and rigged asset, with a single click. Sure, it will probably not stand up to close scrutiny, but you will have a pretty clear idea of the final results; and for some background assets, the auto-generated result may even be sufficient.
However, if you need a final asset that's technically sound and fit for all the later stages of the production pipeline, a lot of these procedural tools will start to break down. Sure, it is still possible to utilize them to various extents, but we're not yet at a point where software can properly replace a talented artist. There is a lot of research and development into such automatic tools; but for now, the more user friendly ones are the better ones, those that can enable artists to realize their ideas faster. So yes, hero and even secondary level assets are still mostly hand built and manually textured; even though the tools can help a lot more.