They would be easy markets to launch if they wanted to, and I'm sure they are important to the people that live there.
Alpena MI for example, has one local station that broadcast CBS and another network as a subchannel. So Directv gives them NY feeds of three major networks, the other one they have to get OTA. So unless they do an antenna setup, they don't get CBS.
What would be most logical would be to add the one channel for the market, which should be cheap given how few people there are in the market. It gets them their local news/weather. Then if possible (spotbeam limits) import the neighboring market locals. So Alpena for example should have their CBS and the other networks from Flint or Northern Michigan instead of New York.
If Directv really wanted to do it right they could, it just isn't a priority to them being such small markets.