We are small, since we currently an Alabama-only affair. Not having national access is certainly a competitive disadvantage. Pay a mostly reasonable service charge for the massive advantage of plugging in on the road. Some or all of that charge would go to the host ISP for their trouble. But even without such a network, smaller local ISPs like ourselves can offer very serious benefits.
Busy signals are rare.
Our prices are lower than most. So far, our tech support staff has an extremely high ratio of wizards to drones. None of these are due to our small size, although the last may be related to size. Most are related to good management policies and planning. I think it does for many people.