I think you have a somewhat generalizing idea of small towns
In a town w/ a pop. of 6,500 I have:
- 1 gig internet (+ starlink, but I only use when traveling now)
- 2 dentist offices
- 4 local coffee shops + 1 starbucks
- 2 grocery stores + 1 walmart supercenter
- 3 gyms (but one is a curves so essentially 2) but none are crowded ever.
As far as international airports, I can either drive to the nearest city, about 45mins - 1hr but I have flown to a big airport from the town's airfield in a small aircraft.
You can find many small towns with many amenities and most of the times you have at least 2 options.
There's no denying there's more variety in the city, but often it's really not the drastic limitations you're imagining.
I will say, with what we do have there's no crowding, everything is very friendly, there's a lot of local options and people will go out of their way to help you.
But God forbid you live in the town 15 minutes from me, it barely has cell service.
You really can't lump small towns together, there's such a wide range.