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What alternative do you have even for many highly-paid professional jobs like doctors?

Doctors are somewhat unique in the fact that they can live and practice in a wide variety of places. Anywhere there’s a hospital, you will have them. Where they will choose to work/for how much is a much wider decision matrix than it is for many white collar organizations which would have no reason to exist (physically) in a small town of 20,000 people. Such a town would require at least a single hospital employing many medical professionals, depending on how far it is from other forms of medical care.

Doctors are just one example and there are many reasons why a doctor may choose to practice in, say, the Boston area than in some 20,000 person town in North Dakota--though you're right than, in many cases, medical professionals have a pretty wide choice in where they live and work depending upon how choosy they are.

But a ton of STEM jobs do require access to labs and other facilities or may have requirements related to security clearances etc. A lot of skilled people can't just work from home and many others travel a lot even if they don't regularly come into an office.

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