Lots of bigger companies like Zeiss or Bosch have many locations and depending on your team you might or might not end up in a really terrible location.

> would that mean life in such a town is worse than in a comparable small town somewhere in the middle of the US?

You lose a lot of the advantages that you listed such as public transportation, walkable cities and free healthcare (availability is terrible in certain locations). But honestly, it's a terrible location to live in, if you want to have any kind of social life, and consider that as a foreigner you probably don't have loads of contacts in the country.