According to the BBC,

The hot spots of Covid-19 are New York, Detroit and other big cities. But small towns across the nation are going through their own wave of infection. Medical experts say the disease could be devastating in rural areas – many of the residents are elderly, living far from hospitals and clinics.

The severity of the outbreak in small towns is determined by a number of factors – towns in sparsely populated states such as Arkansas, South Dakota and Wyoming have been affected only slightly, while those in Ohio, Michigan and Illinois, densely populated areas with big airports and busy interstates, are more likely to suffer.