My home in Virginia essentially sits on top of MAE (Major Area Exchange) East, the confluence of fiber for the East Coast. I could get just about any bandwidth I wanted, if I really needed it (I don't).
By contrast, my home on eastern shore of Maryland is on a rural, lightly populated road where our options are: Hughes satellite (ugh) with advertised download of like 12 to 20 Mbps; or what we have now -- good ol' fashioned DSL! Yes, I'm getting less than 1 Mbps download and about 500K upload! Sooper fast!
There just isn't a business case for any of the providers to lay fiber down our road. The local utility company told me it would cost essentially $17,000 per household to get fiber to each. Funny thing is, my wife and I could sort of deal with the crappy DSL if it would actually work reliably. We can stream a movie (if everyone turns off their devices) and generally browse ok. What frosts me is that I have to reboot the router at least once a day. I've gotten to just turning it off at night. When my kids and/or family visit, it does become unusable.
A couple of my neighbors and me are now looking at BoIP -- they resell AT&T wireless with an unlimited plan (which you can't get direct from AT&T) and some proprietary software on a router. $150 / month, which I'm contemplating now. I can probably get at least 20 Mbps down.