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.