As an American in Germany, small towns here seem a lot healthier to me. Maybe it's just tourist-vision, or that most of the ones I've been to are in Bavaria (which is doing very well economically), but they look and feel quite vibrant.
Personally, I think part of this is that they're urbanist in a way that US small towns almost never are: even cities of 5 or 10 or 20k here are highly walkable, moreso than US cities 10x the population size, with cute downtowns to boot.