It requires more thought to be a medic in a rural area. I have worked urban, suburban, and rural (very rural) ems, and rural was the most mentally demanding.
Working out in the country you will constantly be asking yourself, "Okay, what can I do next?", "What else can possibly be wrong?" The one hour ride to a basic hospital or two hours to a trauma center were very disheartenting at times, because you literally can run out of things to do for someone. That's when you hold their hand and talk, anything to keep them out of the light, you don't get that meaningful time when there is a hospital every half-mile and a trauma center every two.
On the other hand working for a large urban service will make you the most tehnically proficient at what we do. They have a low tolerance for those who cannot get IVs, intubate, or make med errors. They are not forgiving places to work, but you usually have backup a short distance away when you get in over your head.
Of course you probably will never see a PTO gear rip a guy's arm off in your downtown response area either. That was a long ride to the LZ.
Now I work suburban/rural ems. We have a local hospital that can handle most things, but major trauma and dialysis. Dialysis, go figure. The trauma center is 45 minutes by ground, fifteen flight time with four helicopters at our disposal. It is definitely nice. I actually enjoy going to work everyday, something I definitely couldn't say when I was working urban ems.