Or am I just overthinking this?
Yes you are overthinking this as many others have pointed out. I once asked my dentist why he chose to live/practice here (WV) which is not exactly a high-income area. Not poor by any means, but not wealthy either. With his education he could live pretty much anywhere he wanted. His reply was that he liked the quality of life. On his days off he likes hunting/fishing/hiking, among other things. He likes four seasons. He likes his five-minute commute to the office. He has friends who spend big bucks to come here on vacations to do what he does on the weekends for free. And he acknowledged that "Yeah, I could go to D.C. or someplace and make twice the money, but the quality of life would be terrible".
It's not always about the benjamins. One of DW's cousins is a general surgeon, and when he got out of medical school he found a deal from a hospital in an underserved area of Tennessee. If he worked there for five years they'd pay off his school loans, and he had a pile of them. He and his family liked it so much that 30 years later they're still there. He knows he could go elsewhere and make more money but his and his family's lifestyle would suffer and they know it.