You need a cell tower every 20 miles or so, less for a performant one. There's not dark fiber at that density in remote regions (remote is, by definition, lacking infrastructure). There's a better chance of power, and for the cases there's not, solar/battery is fine for a cell tower, especially one designed for lower power remote installations.
Packet loss is an assumption with cellular, so accommodations are built into all stages, including the variable rate vocoders used! And, a bit of packet loss is still better than literally no service, which was the previously, economically driven, state for these places.
There's a 20% increase in satellites planned, with possible 300% increase in the future, so it should reduce.