For me, it's all about connectivity - as long as connectivity is good, away we go. Unfortunately, good connectivity means multiple providers [no matter how good a single provider is, there's bound to be failures or at least maintenance], and stable connectivity from each provider.

At my day job, we are in a location that is served by most major carriers (we are in St. Paul, MN - this means Qwest, TIme Warner, and a few other providers have fiber available), and we are large enough that we were able to swallow the install fee to get multiple fiber providers in.. the monthly bills aren't actually too insane, it's the buildout cost that hurts.

I work with lots of small businesses that are in areas where they can really choose from DSL/cable (both available, both relatively affordable, but 5mbit maximum upstream on the cable and 1mbit-2mbit on the DSL), DS1 (from legacy providers - minimum loop charge of around $600/mo - too expensive for too little bandwidth), or options they really can't afford (fiber builds from legacy providers - $40k+ installation, plus $1k+ loop, and then $50/mbit+ for internet bandwidth.)

Another thing I constantly run into is the lack of native IPv6 support with pretty much every provider that caters to small businesses. (Comcast is working hard to change this - kudos - but I see very little movement from other providers.) This isn't critical today, but working v6 is a *major* value-add already (it makes site-to-site communications so much simpler, even if we are still using a VPN), and it scares me to see how many providers haven't even started on it yet.

Yet-another-issue is lack of local peering (again, MSP area).. for example, for any combination of site<->site traffic between Mediacom Cable, Comcast Cable, and Charter cable, traffic either ends up going through Chicago, Denver, or Dallas(!). Local peering is such a trivial thing - why isn't this happening between all providers?

I'm usually not a fan of government involvement in this type of stuff.. but since they are already involved in (heavily) regulating this industry, I'd love to see a mandate that any new telecom buildouts in municipalities involve vendor-neutral fiber to each neighborhood with reasonable costs to build out from your location to the fiber hut. I know of many ISPs that would absolutely love to be able to offer this type of service, but because of the monopoly on the physical plant, their only option are the wireless solutions - which are also costly and rather slow.