Peering agreements are typically between two networks of comparable size. In the case of a regional ISP wanting to connect to the internet, they would paying for access to one or more Tier 1 or Tier 2 providers and possibly participating in an IXP.

There is much more competition in these markets and plenty of ISPs (e.g. CenturyLink) are also Teir 1 providers in markets where they do not act as an ISP.

Id say its a concern in the short run, but that would incentivize neighboring communities to invest in shared infrastructure and to peer with each other in the long run, esp if their only other option is to be shut out of the market entirely.

Non-ISP transit providers would fill that need. Perhaps the ISPs would pressure them to not. Eventually a lawsuit would put an end to that.

ecommerce retailers would peer with them directly and the entertainment networks would then be left holding nothing.