I live in the mountains of North Carolina and would like to know if the time investment I am making to be a medical coder will be worth it in such a rural setting?

I would say yes - I started out in a clinic as the receptionist/coder.  Then went to the hospital and became the coder and am also involved in the Chargemaster Committee.  Small rural areas allow you to be involved in many departments since you do more than just coding.  It does help to recieve your credentials (i.e. CCS/CPC).  You may not land the coding job at first but will work your way up once your foot is in the door.