People in rural areas can have problems getting service because there has not been enough government subsidy to deploy infrastructure.
Technically the Telecommunications Act of 1996 allocated a ton of money for fiber infrastructure, but telecom providers rolled it out in dense urban areas with a lot of customers, bought each other up and then pocketed the extra cash.
Fiber to the premise in rural areas is insanely expensive but I see it like a modern version of the post office. If you want to be able to write a letter to anyone and have it be delivered you need to set the price so that rural customers aren't paying costs that are orders of magnitude higher.