as someone who has lived in the middle of nowhere US, it doesn't shock me at all to know. the area I live in now feels massive to me (30k population somehow), and back home, where the total population was just over 1000 when I first moved there.
small towns in rural America can be brutal. there weren't many woods I could go and relax in, just my grandparents's house (before they found boars anyways), we didn't live near any geological wonders, the coast was too far for us to afford to go to, and the lakes and rivers and ponds were usually not safe to swim in.
if there is anything "wrong" with you at all, and people find out, everyone will know. I was accused of "performing witchcraft and hexing" students at my school with friends because a singular friend of mine and I had began learning asl together. he and I were happy to tell others, and he liked showing off and explaining to everyone he met, so it was no secret.
I was told to my face that my "stupid ugly" friends should "just go ahead and kill themselves like they wanted to because they're useless tranny faggots". I wanted to never come out and I wanted to scream it out loud so that they'd beat the shit out of me instead. I nearly killed myself in highschool and had a note calling them all out for being backwards idiot hicks.
similarly, being poor in rural areas (as most people in rural areas tend to swing) prevents you from being able to go and do so many things that would otherwise be wonderful for mental health. I've never had any music artists I liked preform within 45 minutes of my hometown. I had to go two states over usually if they were anyone with any sort of notability outside of a niche. there were no third spaces. I couldn't even go to a proper bar when I turned 21 because I lived in a dry county.
the only places for teenagers and young adults to hang out were our own yards, our rooms, fast food chains. the one Mexican restaurant. maybe the library if it were open, but you couldn't hardly talk.
there also are less opportunities for friendship in smaller rural communities. less connections overall. I had a rather large group of friends somehow, id say a good 10 or so people I genuinely cared for. now I have one's contact info and we haven't spoken in God knows how long, and the other I can't even think about talking to without wanting to cry because we drifted hard apart. those ten were about the only tolerable people back home, and everyone else my age left too, or is just kind of awful.
for all the negatives, I do kind of miss my small home town. I miss being able to drive 15 minutes and be in another town. I miss the much emptier highways. I miss the coast. I miss the small town silence at night. I miss driving down dark back roads, listening to my music with the moon as my only company. god do I miss fucking waffle house, and my little Mexican place.
I don't miss the isolation and the overwhelming boredom. I couldn't buy my preferred alcohol, weed was super illegal (and now it's keeping me alive), rent was out of control and minimum wage was keeping me from being able to do literally anything. I lived in a shoebox. my family breathed down my neck for every little thing.
I'm still sad, I still want to die (obviously, I'm here), but it's better here. There's different weather. I can drive to go see mountains, or a capital city where people are thriving. I can go to any number of cool touristy things now. my public library actually has funding. there's 2 local farmers markets!
I think if I hadn't been fucked so hard mentally as a kid, I could've genuinely been happy here. My brain is broken beyond repair, so now I'm just living quietly and a bit more comfortably. If I were more "okay", I have more assets at hand here to actually thrive, and I think that's why I see so many transplants like me. (though they're far more 'local' than myself. it's not like how many people move to NYC. think like 2k "new" people over 5 years, most coming from the south of the state)