I can really only speak for Rochester and Buffalo, but know the places quite well. Both cities have somewhat of a midwestern feel. There's a bit slower pace than the NE, the people are friendlier, homes are affordable, etc. Rochester is a bit more educated as a town (generalizing a bit) -- more educated, better schools, nicer suburbs. Buffalo is a bit more blue-collar, but still has some very nice areas around. Buffalo's a much bigger city than Rochester (about 500,000), but neither city has the feel of a big city at all. The night life is very limited in both places. But, if you have a family/significant other, either would be a very tolerable place to live for 5/6 years. If you're coming from a big city or from the NE, you'll be taken aback by how friendly everyone is there, especially in Rochester.

For a single guy, beware. There are very few single residents in either program for a good reason -- not much of a singles scene in either place.

All in all, I truly loved my interview at Rochester. Great program, really friendly people, amazing facilities, amazing faculty, amazing reputation, and a beautiful hospital that makes money and puts a lot back into the Ortho dept. Buffalo I was a little less impressed with, but it still has a very good and well-balanced program. Like the city, it's a bit more blue collar.

The statement you always hear about Winston-Salem (Wake Forest) is that it is a great place to live and raise a family. It is a great Southern atmosphere and a good place to settle down. It also probably has a little more of a singles scene than some of the other cities on your list since it has the undergrads near by. I know ortho there covers all the college sports teams, so you at least have ACC sports as an option which is more than can be said for some of the smaller cities you mentioned. Most of this is coming from visits and friends that live in the area and not personal experience so don't take it as gospel, just a little idea of the city.

Geisinger is an outstanding small program but is in a tiny town in the middle of nowhere in PA with little as far as the cultural aspects, nightlife, and sports/entertainment.

I saw a sign for "Mama's Dutch Kitchen" in Geisinger.

I don't know if that helps, but gives you an idea of the nightlife.

But the program is excellent.