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Usually there is a single local service telco for a given region, but there are probably six of them across the country

This isn't quite true any more. Now there are ILECs and CLECs (incumbent/competitive local exchanges) and all sorts of things. The ILECs have to let the CLECs have access to the lines, and in exchange the ILECs get to provide long distance. The US Telephone system is amazingly convoluted and impossible to understand. AT&T("ma bell") used to own and run everything. Then the courts broke up AT&T into RBOCs (regional bell operating companies - also known as - wait for it - ILECs). AT&T was left as a long distance carrier only. Then, the childen of the court mandated breakup of AT&T began - wait for it again - buying each other. Just recently, our local RBOC/ILEC - which started out as Pacific Telesis, became Pacific Bell, then became SBC - just bought AT&T, and promptly changed its name to AT&T.

This rabbit hole just gets deeper. Any decent voip provider should be able to give you numbers just about anywhere. Buy you should really just get an 800 number, which can then be forwarded to any us number of your choosing.

Matthew