There are food deserts in Appalachia without either grocery stores nor any fast food chain restaurants. She’s probably talking about the most economically stressed areas in rural America.
Could you identify one such area, ie a county or something that does not have a single grocery store or restaurant ?
The USDA has an entire map of them.
That's a measure of distance to the nearest supermarket, It doesn't count resturants or fast food places which would have Ketchup Packets.
Most likely for restaurants, in order to save costs they have to just have a fixed section for condiments. I’ve seen it in several smaller fast food joints and in Uni.
I think the point she is making is that many businesses cut corners in rural Appalachia because they are not worth the cost, while the same isn’t the case in more upscale rural areas. A mundane, small difference that is glaring though. And as a poor coal miners daughter with family and links to these areas, she would be the one to know and be impacted by the difference.