I lived and worked in two small markets with significant big-city signal penetration.
The first was Bishop, California---population 3,500. KIBS, where I started at 15, was the only over-the-air signal you could get, AM or FM, during the daytime when I started, but there were a couple of asterisks: At night, major AM signals from both Los Angeles and San Francisco came in like locals---KFRC, KHJ, XERB, KDAY and others. I had to compete against Dave Diamond, Humble Harve and Wolfman Jack.
Plus---not widely known at the time---if you had cable and put an FM radio close to your TV (or hooked it up to the cable, you could get every FM signal with a stick on Mt. Wilson---KNX-FM, KMET, KLOS, KRTH, KKDJ, KOST, KBIG and others.
Once that knowledge got around, adults in the daytime increasingly tuned into KIBS for the local news, the school menu and the road conditions and that was about it. The rest of the time, they were listening to L.A. stations (270 miles away) on the FM via cable.
The second was Ukiah, California. 110 miles from San Francisco. Three local stations there, one AM and two FM. Terrain kept most of the San Francisco FM signals out, but the AM stations---KSFO, KFRC, KNBR, KCBS, KGO and others---came in like locals day and night.
I worked hard along with the staff and the chief engineer to make sure that when you tuned to KUKI, it wasn't a letdown from SF radio---the music was on-target, the jocks were largely people who were going to large markets, they just hadn't gotten there yet and we had one of the earliest Durrough multi-band processors in the racks. We acquitted ourselves nicely.
All that said, though---we ABSOLUTELY lost hours of listening every day to San Francisco signals.
And this applies in larger markets, too---in the 1970s, Sacramento Top 40s had to fight off KFRC, even though it was 85 miles away in SF.