I believe it is commom for the tower in this situation to have a point to point link to the another tower.
Bouncing off a geosynchronous satellite makes the latency awful, but it is an option. Fiber, copper, or point to point wireless are better options, though.
Latency for bouncing off LEO satellites isn't too bad though.
They are often off in the woods, though! Do some connect to satellites?
Edit: apparently satellite backhaul is a thing but kinda rare.