Since (as a co-worker once said) most South Dakota medical facilities are triage until you can get to Rapid City or Sioux Falls, my wife and I took another one-day trip to Sioux Falls and back yesterday for a doctor's appointment; seven hours of driving for a one-hour visit. To be fair, this was to see a gastroenterologist, not a GP, but then I live in what is supposedly another major city, the State Capital. It is another example of life here; if you want anything beyond basic services of most types, you go to Sioux Falls or Rapid City. Most other municipalities are just small towns with extra people.
A former co-worker used to say that he was all in favor of the "Buy Local" idea, and was willing to pay a little extra to do it. But when he could drive to Rapid City to purchase the various items he needed at sufficient savings over the local retailers (if they had what he wanted at all) to more than pay for the trip, even allowing for his time, buying locally was just stupid. My needs are generally more basic and harder to justify travelling to fulfill, but while we were in Sioux Falls we stopped at Hobby Lobby so my wife could purchase yarn she was unable to find in Pierre. Not yarn made from Yeti hair or dyed some exotic multicolored hue; just basic yarn in colors appropriate to her project.
At one time it was the supermarkets and large stores that separated bigger cites from smaller ones. Now with Wal-Mart everywhere it's the specialty stores that make the difference, selling things that mass-market operations don't carry (such as yarn; I've been told Wal-Mart is gradually phasing out it's craft section) .
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