Rural ISPs in the USA have unique problems
I've helped some of the one man ISPs that are represented by WISPA. They tend to be providing service in regions that have very low population density centered around monopoly controlled areas. They often will have a few wireless access points on a radio tower but will have to backhaul the uplink feed to a remote larger city because the local towns ISP only covers a few blocks from the exchange. The owner of the exchange may not be willing to sell upstream service to a competitor or will sell but but mess with the speed and that assumes they haven't oversubscribed their link to the exchange. Another problem is the density is just high enough to make things expensive. If you can get a fiber line from a larger town, you still have to run it though intermediate towns and that might require going around it. Many power companies think they are in the ISP game yet won't or can't provide service so leasing space on their poles is out. The regulations are a mess as they might be federal, state, Indian, county, town, home owners associations, water authority, electrical authority, telco co-op, sewer authority, federal or state parks, railroad or even the army corp of engineers and those are just the ones I've heard about. Some of these ISPs are replacing dialup services that wouldn't do much over 9600 baud and sometimes cover areas where satellite coverage is even an issue due to steep mountains.