A lot of it has to do with nepotism. There are threads with pretty good breakdowns of who in smaller towns throughout the country are related to or grew up around big guys in NY, Just do a search for any given town and you'll find some interesting posts on its history and how their early bosses were connected to influential people in NY.
"...the successful annihilation of organized crime's subculture in America would rock the 'legitimate' world's foundation, which would ultimately force fundamental social changes and redistributions of wealth and power in this country. Meyer Lansky's dream was to bond the two worlds together so that one could not survive without the other." - Dan E. Moldea
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