Cost of customer acqusition. States have to be bagged one-by-one, each with an insanely long sales cycle, your profits have to cover those nice salespeople's salaries, while leaving you with sufficient profit to cashflow expansion.
This is not a dev problem; the sort of orgs which are prepared, and can cashflow these sort of sales simply don't have (nor are they incentivized to have) any dev culture whatsoever.