A "nice" category $\mathcal{C}$ should be (for the purposes of this question) locally presentable at a minimum, and maybe a bit more. One might require $\mathcal{C}$ to be (in order of increasing restrictiveness)

• ABn for some $n$.

• Grothendieck

• locally finitely presentable

• etc.

For instance: if the category of quasicoherent sheaves on a variety has enough projectives, is that variety affine?

EDIT Just to be clear, I'm well aware of the Freyd-Mitchell embedding theorem. This is not a question about how close abelian categories are to module categories -- it's a question about how restrictive it is for an abelian category to have enough projectives. The local presentability hypothesis rules out the duals of categories of sheaves for instance.

I'm thinking of things like this result: the category of sheaves on a locally connected topological space has enough projectives iff that space is an Alexandroff space -- a very restrictive condition. I suspect that the category of sheaves on an Alexandroff space is a module category additive presheaf category.

For another example in this direction, consider the fact that the category of quasicoherent sheaves on a smooth projective variety of dimension >0 over a field never has enough projectives.

(Note: the original version of this question asked if $\mathcal C$ must be a module category; in light of Qiaochu's answer I've revised this to ask if $\mathcal C$ must be an additive presheaf category. I'd also be interested in showing that if $\mathcal C$ has a compact generator and enough projectives and is "nice", then $\mathcal C$ is a module category.)