A little difference, I admit, but nevertheless, important. The doc is quite well here:
save!
With save! validations always run. If any of them fail ActiveRecord::RecordInvalid gets raised.
save(perform_validation=true)
if perform_validation is true validations run. If any of them fail the action is cancelled and save returns false. If the flag is false validations are bypassed altogether. See ActiveRecord::Validations for more information.
so, save! won't just return true or false but only true on success and raise an excpetion if it fails.
The purpose of this distinction is that with save!, you are able to catch errors in your controller using the standard ruby facilities for doing so, while save enables you to do the same using standard if-clauses. At least thats what I think.