I have friends 15 miles from Washington D.C. who are on dialup (or Verizon wireless cards) because it's apparently not cost effective to run cable or DSL to their neighborhood. My folks live in Montana. They don't even have good dialup. Forget 56k, they're falling back to 14.4kbps.
I'm in suburban VA. No DSL and my Comcast loop is so saturated that I don't even bother trying to use it at prime time.