It's also the urban centers from the rest of some states. For instance I live in MN, the city center is very blue and the rest of the state is not.
It's mostly urban vs rural, even on the coasts and in states like CA.
Of course, smaller exist! There are functioning towns in East Texas with less than 500 people in them! My favorite is Caledonia; cherished memories are that upon crossing the border my father would pull his best BB King impression and belt out the eponymous tune.