There really aren't huge difference between the "top" programs around the country. While county programs may have a more diverse patient population or the 'underserved" patient, when you look at academic places I don't think there is a huge difference in what you mentioned above between places like OHSU, Davis, Stanford, Denver, UCLA, Vandy, UTSW, etc.
But I do agree with you that it's good to have some reason other than the outdoor activities or city activities for liking a program, and at the same time I do think it's a shame that you can't just be totally honest and say that you are happiest in x, y, z due to the environment, city, and COL in the area. After all, most of the faculty stayed in the area or migrated there after training for one main reason....
If I had to go to residency in NYC I would be depressed beyond all belief. Same with U of Nebraska. Some places offer great training, diversity, teaching, etc and aren't even on my radar b/c of where they are.