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Infintevalence pretty much nailed it
We're country as fuck up here. Not a small town any more, but still more rural than suburban.
While we're in driving distance of a good hospital, it's a drive, not something in town. There's just not enough people to keep a hospital in use often enough to make it reasonable in a capitalist system at all, but even in an ideal, post scarcity system, the resources to build and run hospitals are going to be best located where the most people can benefit from it.
And pretty much everything scales the same. Why locate a big university in a town with maybe 10k people if you include outlying areas? To support that kind of endeavor, you'd need more people to do the work, so the town would get bigger because of the large undertaking.
It's a balance. If you want to have bigger centralized services, you need more people to make it work. And, if you don't already have the population, attracting bigger things is harder, so the chances of things like public transit, resource intensive facilities, exotic supplies/foods coming there are lower.
It results in people that value the benefits of a smaller population center over the usual benefits of a bigger center being the only ones that'll move out