I'm not sure those "well-maintained urban spaces" are as simple as you seem to be implying. They have plenty of quickly-changing construction in the middle of active roads, out of date / invisible signs, and far more crazy drivers and pedestrians to interact with per day than in Middleonowhere Pennciltucky.

As to garbage trucks: ever seen people pull U-turns randomly in the middle of the road in a busy city, or dive across 4 lanes to make an exit? Garbage trucks seem simple by comparison, and at significantly lower speeds.