And it can easily be a 5x multiplier, sometimes more.
This dynamic extends beyond usa. Even in India, doctors command high salaries in rural areas, often 2-3x what they can in metropolitan cities.
A developer is even more relocatable than the doctor. You can still work for a major company and you still have the big city market open to you, even if you live in a small town. Whereas for a doctor it's a major career change.
I have several friends who talk about moving somewhere cheaper, but way more of them are perfectly happy to live in an awesome city with lots of stuff to do.
Though, to be fair, there are a ton of awesome NON-podunk little towns that are a delight to live in.
In any case, one will need to put in the effort to get one's children properly educated. A smaller school district probably gives more opportunities to experience a wider spectrum of activities anyway - I certainly wouldn't have been able to be a three sport athlete, take every shop class available, participate in math and geography competitions, and a whole host of other extra curricular activities in a bigger pool.