They more than likely know what the issue is, but the priority to fix it is not a concern. If that's the only ISP you feel is best, then the "best" doesn't have to improve. This is why de-reg in Cali sucks, and why the sticks need more access options. Monopolies are just hard to deal with.
Our ISP was run out of my home for a while in Bumville, KS. I maintain the hardware, another came in and did the brain-work. "Backbone" issues with that were just contracts on our side to get a good pipe. And that's hard with just under 300 users and no pipe close. So we knew our problems and couldn't fix it even if all of the 1,700 people in the city wanted internet. And then the logistics looked bad. Since then they laid down the copper and got the town up to speed. But some things need the big guys to notice an area and help out. I'm not laying down copper, that's for sure. I'd have to triple rates in a cow town.