-There are very few high paying jobs -There is limited access to medical care -Local government ineptitude has a very real daily impact -Small tax base means surprisingly high taxes, but real struggle to maintain infrastructure (especially schools) -“Traditional” upbringing, often religious based, that breed skepticism toward anything “foreign” - which means everything from non-white people to AirBnB. -A fear that Washington DC really is a threat to their freedoms. For example, there is a view that gun laws aren’t really about guns, so much as a perception of a slippery slope toward totalitarianism.
Those are just kinda off the top of my head… but having now lived here in small town, rural America for eight years, I can sympathize with some of their views. People in small towns are not all the slack-jawed yokels city dwellers like to believe they are - many are well-informed and well-educated. By and large, they have legitimate concerns, even if they can be misguided in their beliefs about the potential solutions — and politicians to help them achieve those solutions.
My $0.02 — small towns need to be more entrepreneurial. The government isn’t going to fix it for you. Trying to recruit Amazon (for example) to put a warehouse there isn’t going to bring the desired economic outcomes either. Do it for yourselves.