Do they? I just moved back to the rural area I grew up in after spending ten years in Cleveland.
Cleveland's not the greatest, but there's dick around here outside of Walmart. I can drive 30 minutes into the nearest small city if I need a Home Depot or something, but Cleveland had tons of choices by comparison. Not a ton of restaurants, most are same ish or eaten up by Applebee's. Fast food is even pretty limited.
Back in the day we had small shops, but most are dead now...