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I think the idea is that the sats relay a signal to radio stations including remote ones.

It's the radio stations who are in charge of situating their reception equipment where it can see the sat, and also for figuring out how to best broadcast to their served area (e.g. AM and/or FM? Tower height, power, setting up some translator stations on a different frequency to serve outlying areas, giving the feed to local cable systems to be sent with TV service, etc.)

It's definitely a mixed bag, but the areas I'm thinking of have decent FM radio coverage (from local stations that affiliate with public radio). AM coverage tends to be good regardless.

I've had the same experience as you around remote places, but those places were generally the flat-and-desolate kind :-)

Most towns have the repeater(s). They are cheap and easy to maintain.