In my small city in Michigan, for example, there's exactly one phone company and one cable company for residential uses. But there are 4 different local companies selling commercial bandwidth backhaul, in addition to nationwide major providers like Level3 and AT&T.
If you're somewhere truly rural, this can be an issue, the local monopoly might not let you buy commercial (re-sellable) bandwidth. But in most cities -- even small ones, it's probably not a major issue.
At the moment, commercial ISP services are still somewhat competitive. It's the residential ones that are completely monopolized.