onCreate() is called when the Service object is instantiated (ie: when the service is created). You should do things in this method that you need to do only once (ie: initialize some variables, etc.). onCreate() will only ever be called once per instantiated object.
You only need to implement onCreate() if you actually want/need to initialize something only once.
onStartCommand() is called every time a client starts the service using startService(Intent intent). This means that onStartCommand() can get called multiple times. You should do the things in this method that are needed each time a client requests something from your service. This depends a lot on what your service does and how it communicates with the clients (and vice-versa).
If you don’t implement onStartCommand() then you won’t be able to get any information from the Intent that the client passes to onStartCommand() and your service might not be able to do any useful work.