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like much of North Dakota, South Dakota, rural Minnesota, rural Iowa, rural Wisconsin, southern Illinois, rural Missouri, etc. end up showing and aggressively advertising/recruiting much, much higher offers than metro areas even a few hours drive away. Take a look at popular job sites or talk to people working in those places and you'll see what people are talking about.
I think the pattern you are describing reflects in many ways bigger social forces. A well trained NE academic psychiatrist may very well consider a job in Twin Cities, and even have friends there, but would NEVER EVER in a million years consider a job in rural Wisconsin, or even rural New Hampshire (which in substance are actually much closer in each other in terms of life style than the lifestyle of living in Boston, which is maybe "a 2-3 hour drive away"). There are lots of newspaper articles about "Two Americas". I think this is a reflection of this. Regional differences get easily trounced by the "urban-rural divide".