Heh... I'm out in the middle of nowhere... well a small village of some 3700 people... we have exactly 3 ISPs that will service me, and most are not the big names.
I have Windstream, which of the three is the only straight DSL provider, and they only have me 3mbs, because that is all that is offered in my village. They are however by far the cheapest. Yet they have proven fairly reliable.
As slow and pathetic as my results are compared to many, I've found I really do not need more all that often... only my mother resides with me, and she pretty much limits herself to browsing and YouTube and Hulu free/Crackle/Crunchyroll...
Only the rare times we both stream or do something draining do we really notice it.