So what would you call small towns with little economic activity, likely little to no entertainment activities and forty minutes or more to the nearest decent sized city.

I grew up in a hick town most famous for young women disappearing and people dying of overdoses. Almost everyone with any real ambition left. If you don't have an in with the papermill or the truck factory you're gonna be stuck driving an hour to find a decent job.

Family can definitely make living in such a town much more tolerable, but absent that I'd vastly rather live in/near Pittsburgh or Philly, etc. With the current war on education by many people in such towns I'd never move my kids to such an area unless I could afford private school or homeschool.