Here in washington state, many rural areas only have dialup, because they don't have the money to run high speed microwave to the small towns. Some islands on the west coast have many retired millionaires, so they have high speed due to point to point microwave.
The small town my family is in, has a small point to point microwave, that Verzion and comcast rents off a small ISP, so they can bring in service. 80 homes have comcast, but only the town library has a 5meg wifi for the town. People drive up just to check mail. Verizon coverage is helpful, but gsm has no coverage.
They don't sell sat internet in Washington state due to over subscribing. Everyone waiting for the new viasat 2 to launch (already delayed) till Q1 2017, and viasat 3, so rural areas in the US can get high speed (but limited) internet.