A lot of exceptions apply.
Sana'a, the capital of Yemen, is located at an altitude of 2,250 meters (approx. 7 thousand feet). It has almost three million people. Pumping required amounts of water from sea level to such heights is quite a challenge.
Tehran is at 1200 meters. Tabriz, 1350 meters. Mashhad, 1000 meters altitude and far from the sea.