Rural has nothing to do with it. It's 100% about the network and internet service delivery.
We are a small rural ISP doing gigabit fiber and I personally live in a city with a coax/fiber/FWA options. Gaming works just fine on any of them.
I don't believe there are any cache boxes for games, I haven't seen anything along those lines but bandwidth is pretty cheap for us - it's getting it to peoples houses that's the expense.