It's almost like the poor lifestyle choice they made was living in a rural area and not keeping a garden.

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.