In my time working around poor access to highly reliable, or even highly available business class networking, one thing became incredibly clear, when you have access to it in those kinds of areas you need to make the most out of it. That's why I've became such a big fan of meshed networks built around using wifi point to point devices, private fiber, and ethernet packet switching.
When you have a gateway, MPLS or other device that you can tie in to in one local region, with high costs for a last mile to be ran, it only makes since to build your own infrastructure and share it out to all of your end points. With my work at the Kentucky RHIO deep even deep in appalachia with mountains and hills everywhere, we had great success using wireless point to points to bridge the gap between areas it was possible to have direct last mile connections, and ones that it was not.
In many settings we were able to establish highly reliable SD WAN like connections building off our own networks, Cisco Meraki's "magic" like VPN systems (separate license needed) and further use of private fiber tying back in to major ISPs or local DSL carriers to give redundant internet and critical system access, and most importantly wireless systems like the ones offered by Ubiquiti to make private connections that simply would not be feasible with traditional copper or optical physical connections.
