Speaking as someone who lives in a rural area - this ain't it. The lifestyle choices are the biggest problem. Availability is just addressing the problem at the end of the problem.
I have lost 35lbs so far this year and it is pretty shocking the health benefits of not over eating good tasting food.
I think we all know this too but are collectively in denial because it is so boring eating chicken breast, broccoli and mustard yet again as I am right now instead of the awesome tasting dish from the incredible restaurants we have all over.
That is even with not drinking, not smoking and going to the gym for years.
People don't just want their cake and eat it too they want their cigarettes/vapes and smoke them too, a six pack and drink it too, a pizza to eat before the cake,all while only abstaining from physical activity.
My perspective may be skewed by my relatives who live in rural Appalachia. They keep gardens, have physical jobs, and hunt for meat. They live a few miles outside of a small town whose hospital just closed - the only one in the county. They do have a proper emergency care center that's designed to be able to get you stabilized and then transfer you to a hospital outside of the county.
You're right though - the people that live "in town", population 6,000, tend to live like urban folk without the urban amenities like you mentioned. I have no idea why people choose to live like that.
It is more that the poor lifestyle choices were already made, so it is most convenient to live in a rural area where there isn't as much social pressure to change. You can easily hide when you live on a desolate backroad. It is hard to hide when stepping outside means immediately running into hundreds of people ready to judge your "undesirable" behaviour.
> population 6,000, tend to live like urban folk
The USA defines urban as a population of at least 2,000 people, so those in that place with 6,000 people don't just live like urban folk. They are urban folk!
> I have no idea why people choose to live like that.
Many, if not most, times it's not a choice. Limited skills, limited education, limited drive, and limited exposure leads you to stick around where you are because you don't know any better.
> and not keeping a garden
I'll give you this. It was a thing, a big thing, when I was younger. It makes me think people have honestly gotten lazier - there seems to be no drive or desire to do so.
I eat some meals that are healthy, and some that aren't. None of them are organic.