I’ve spent a total of 45 years in Midwest suburbs and 5 years in NoVa. I did not like healthcare in the big city. You have to go in and pretty well know what is wrong and what you want them to do about it. If you’re just feeling off with a bunch of random symptoms, they don’t have time to listen to all of that bullshit in the city.
I’m honestly much happier with healthcare here. I’ve never felt my doctor rushing me out the door the way I did on the East Coast. I had to go into the hospital in Orlando with the worst headache and sweating I’ve ever had (and that’s saying something because I suffer from constant migraines) and I sat in the waiting room for about 8 hours before I left to go suffer and/or die in peace and quiet.
All I’m really saying is healthcare is a lot more nuanced than rural vs. urban.
Jobs? I don’t know. The pay is less here but so is the standard of living. Other than being a tech worker in silicon valley, I’m not really sure what is missing here. I guess maybe the jobs skew more toward blue collar than banking and legal and stuff, but I’ve been a white collar working almost my whole life here in the Midwest (as a programmer working with banks and courts as well as industry and retail) - there is certainly no shortage of such jobs I can see. I suppose there are fewer employers, so it’s harder here to tell your employer to get fucked and you’ll go work for someone else, but just look for the job first and then tell them to get fucked and you’re fine.
MSU and UofM are both pretty good schools, though I’ll concede they aren’t ivy league.
I can’t speak to heroin here because I’m pretty far removed from the drug scene - that seemed a much bigger problem in NoVA than here, but I’m sure there is plenty of meth in the rural areas, but from what I can tell the suburbs are mostly legal pot and probably cocaine (just judging from the billboards I see).
I’m not trying to argue with you, just offer a different perspective. I couldn’t handle the crush of people and ultimately that’s why I left, but I also learned how much I missed from where I grew up.