I have lived in small, middle sized and large cities and the answer is no. There are jobs for designers everywhere. Your best bet is to find a smaller city with a good industry. For example, Raleigh-Durham, NC has a huge technology sector, but you can live in a smaller town and enjoy the benefits of a big city job. It also depends on what exactly you want to do. There are design jobs everywhere.
Rachel recommends the following next steps:
- Figure out what size city makes sense for you
- Find the industry in cities you like (healthcare, automotive, technology) and figure out what part of that industry you want to work in. Would you want to design logos or make ads? Do you want to design systems (Ex: technology systems, web sites) or are you more interested in traditional graphic design? (brochures, identity, etc)
- Enroll in a design program that's right for you. Find a 2 year portfolio school or 4-year college program.