As with everything it's the last 10% that takes 90% of the effort.
Or in this case the last 20-30% depending on how small you define "city".
The 2000 census found 58% of the US population living in "urbanized areas" of over 200,000 people and and 69% in areas over 50,000. [1]
So, even if you have blanket coverage for every urban/suburban area over 50,000 population, you still have over 30% of the US population to cover. [2]
Even AT&T with its existing investment has to be compelled by law to provide services in these areas where it is not economically viable to do so. The "Universal Connectivity Fee" on your telephone bill helps compensate for the losses. [3]
So, until either high-bandwidth long-range omni-directional wireless becomes portable and energy efficient or the government requires/subsidizes universal coverage, alternate technologies are not going to go beyond boutique "alternatives" for urban folks.
[1] http://www.fhwa.dot.gov/planning/census_issues/metropolitan_... [2] For example, Southwest Bell had to set a number of poles and string over a mile of cable to my parent's house. We had friend where that run was over seven miles for a single customer. [3] http://transition.fcc.gov/cgb/phonebills/samplePhonebill.htm...: