This is huge...if it survives appeal.
Google's app store is a vertical monopoly and quite obviously anti-competitive. (Apple's is too and a ruling here will make it easier to get a ruling aganst Apple)
The big winner hear is most likely to be Amazon -- which has had to remove purchase capabilities in Android in order to preserve their margin (and because negotiations on Google's "cut" failed, mostly because there was no fair cut). In general, the big winners will be, like Amazon, exisitng payment/financial or paid websites systems that have Android apps.
The status quo has them refuse to accept payment via apps or accept Google's/Apple's blackmail and give the phoneos companies a share of revenue, but Google does very little to earn this money.
Re alternative app stores, very few make sense, but there are places where marketplaces might have a good reason to exist. It would be lovely to have a vetted repo for Open Source Android apps, for instnace, rather than having to fiind sideloads or for all of them to pay App Store prices to distribute free software.
WRT the idea that scammers will be the big winners? Nothing in the ruling requires that Google not do fraud protection. Obviously, if people install (non-fraudulent) app stores, they might be at risk that the store does a worse job of vetting apps than the Google App store does, but it's not like Google has done a great job of preventing malware from getting downloaded.