The rustbelt, deep south, and Appalachia are not some beautiful, middle class paradises. They're full of towns littered with heroin and meth addicts subsidized by welfare and petty crime. You just don't see it or read about it because it's across thousands of small towns and not concentrated in major cities, where media also tends to live.
These places have a lot of violence, social issues, drug overdoses, etc. They may not have homelessness at the same level because housing is cheaper and in many cases involves a trailer or an old house in disrepair.
I just spent a few days in Birmingham, Alabama. The downtown streets were so clean you could eat off of them.
It is really hard to come back to Seattle and see all of the trash everywhere. In the Seattle airport one of the bathroom stalls looked like someone had used the floor as a trash can. There were orange peels, discarded shoes, and various other trash sitting on the floor next to the toilet.
Social problems exist everywhere, but that's no reason to give up on having pleasant and usable public spaces.
Birmingham has all of its black people locked up with some of the highest incarceration rates in America. They'd just arrest your ass and throw the book at you if you camped in the streets.
Offer people food and shelter. Hopefully they will take it. If they decline because they like the streets better, there has to be some recourse. We can't cede the health and safety of public spaces because we are too afraid of having to ever tell a person "no." It's not compassionate to let people live in dangerous and unregulated encampments.
Prisons are just used for too much. I wonder if there’s a coincidence in incarceration rates increasing as we phased out mental asylums. Asylums had some issues but maybe there’s a middle ground between lobotomy and todays situation of treating so much as criminal.
These places have a lot of violence, social issues, drug overdoses, etc. They may not have homelessness at the same level because housing is cheaper and in many cases involves a trailer or an old house in disrepair.