There are certainly people who are convinced that they can only find meaningful work in a handful of tech hubs--first and foremost the Bay Area. I'd argue they're mostly wrong but you won't convince many of them.
However, there are others who genuinely like the Bay Area in spite of all its downsides for reasons that I even somewhat understand when I visit. The culture, the lack of snow, etc. Others are like New Yorkers who consider every other city a provincial cowtown.
As someone who kind of feels this way, I guess it depends on how you define meaningful. I grew up and live in the Southeast. Its not like there arent jobs out here, but majority of jobs around here a corporate, "code monkey" jobs. Yeah, there are startups and some markets that are outliers, but its rare for me to see a job in this region and thing "wow this would be a really cool job". OTOH I've seen job listings for companies in say, the bay area or Austin that seemed really interesting (to me), from companies large and small and it just seems to come down to where the companies have offices.
The reason why doctors get paid more in underserved areas is because very few highly educated people want to live in rural Alabama, even if the houses are cheap.
I certainly wouldn't want to trade Amsterdam for the town I grew up in. Then again, my dad clearly disagrees. On the other hand, Amsterdam probably isn't quite as expensive as London, New York or San Francisco.
"Nobody goes there anymore, it's too crowded."
Really? My impression is that nobody wants to live in expensive tech hubs where they can't even own a place to live, but they can't leave because there is much less work elsewhere.