The narrative that rural counties depend on the centers for their infrastructure needs is a view that was created by the cities. In practice, people is small towns and rural counties are extremely self-sufficient. They know help isn't coming their way, and therefore are totally okay doing what needs to be done to preserve their communities' health. People grow their veggies, raise their own pigs, hold three jobs to pay the bills ...etc.
People in small towns really couldn't give 2 f()cks about people from the city, but they get pissed off because city people come and try to tell them what to do. Basically, they've not asked for any help from cities before, so why should they be handed down constrains now?
At least that's what I've seen.
The narrative that rural counties are extremely self-sufficient is utter-nonsense, cult-like thinking. They don't have the population, tax-base, or non-individualistic thinking to do anything at all. They're dead in the water without outside funding, which comes from the state/county where people actually live/work.
As for jobs, their main employers are typically some combination of tourism, ranching, and most of all, government. Often it's colleges and medical facilities that are the largest employers overall, which critically rely on state funding.
I've definitely heard people in these areas who say they don't need doctors, schools, or roads, but hopefully we can agree that it's a silly position and not an argument most people would make.