Depends on the country. There are places with "mountains next to open grass lands next to coastline next to forests within a few miles of each other" (where few, eg. 100 miles). The world is not all like Utah US50 or whatever huge expanse.
But even so,
(1) there's something exciting on its own for driving in real-mapped as opposed to some fake designed terrain
(2) for certain games, it can main point (e.g. I can imagine a "route 66 hot rod race" or a "drive Monaco Rally" (and of course things like MS Flight Simulator, combat games, etc)
(3) There's absolutely no reason why a game couldn't use real world data and cherry pick different terrains for variability from those...
(3)
Humans are creators. Humans build things larger than themselves.
Nothing is perfect. Choose what to focus on.
Self driving cars can't (and don't) rely on maps to prevent injury or death. They only use to know how to go from A to B in the most general way -- and they'd still need to check for bypasses, closed roads, etc... (on top of the real-time, processing of obstacles, vehicles, lanes, traffic lights, weather, and so on).
Allows you to fetch real world height data for use in Cities:Skylines (and any other game that uses heightmaps, pretty much).
edit - Can build scenery off of OpenStreetMap data http://wiki.flightgear.org/Osm2city.py