there are many micro / local ISPs offering wireless connections in third world countries. i consulted for one in bolivia and helped start up one in serbia
i consulted them on biz and sales side so i don't remember their gear, but i remember both had quite a basic setup that worked pretty well. mind you, it was in urban areas (a 600k city in bolivia and a 2m city in serbia). serbian guys gone as far as building a file sharing network and setting up game servers
In the US I've had the most luck in fairly dense suburbs outside of major cities. If you get too rural it's hard to get the density where it needs to be to have decent profit margins. I honestly don't think there's any reason it couldn't work in urban areas in the US, just a different set of constraints. But it does seem to be less common.