markrichardb: I've heard most Internet users in America have only one option because the big telecom companies stick to their turf and keep out of each other's jurisdiction like mafia kingpins. If a customer is disappointed with the service, they have no recourse.
There's usually more than 1 choice, but people don't consider satellite services to be viable options. Then they vote in officials who regulate the service providers in the region to the point where it ends up being an exclusive contract agreement with 1 of the big players for their lines installation. Most of the problems people have with a lack of competition would be resolved by paying more attention to their local politics and actively participating. The government will offer grants for companies to provide for rural areas.
My area was locked to Frontier, but they never finished installing their infrastructure so most of us have been underserved for years. We voted them out and have a gigabit provider coming. Going from 1.5MBps to 1000/1000 will be something. :)