I'll agree with the latter point, but I think having less per-capita emergency services is a bug as opposed to a feature. I'd be willing to bet it's a matter of the land/buildings/employees necessary to run such services are far more expensive in areas where land/labor/everything is more expensive.

There are less absolute services available in rural areas and less services per capita and that lower level of services still costs more per capita to maintain, because for that one ambulance to serve ten people it had to travel 200 miles and took ten hours instead of having ten ambulances serve four people each in two hours.

If you look at only the most rural areas sure, but that isn't where most people outside of cities live.