The first issue is that ad auctions are 2nd price, meaning that if an advertiser bids really high, they still only pay the 2nd-highest bid + $0.01. Of course the publishers wouldn't realize much from this. Second major issue is cookies and scale. You can't get high-value bids if advertisers can't recognize those users.
The industry is slowly moving toward quais-first-price but scale is a fundamental problem, which is again why Facebook, Google, and now Amazon get all the money and do really well with behavior targeting while even big publishers struggle. Add in the new privacy regulations and this will only further widen that gap.