I loved (loved) WVSOM when I visited, and I'm OOS too. I could really see where the money is going - new bldg for clinical skills, top-of-the-line human patient simulators, amazing anatomy lab...etc....but yes, it's very expensive.
At the end of the day, if you're going to do internal medicine/OBGYN, then you can apply for the primary care loan (no interest until after your grace period of 1 yr, & rate is 5%). So this can help you deal with the huge debt you'll get from WVSOM. You can also do loan repayment through the health services...you'd be surprised how many areas are considered 'underserved' - go to their website to double check the areas. As long as you're practicing in some kind of medically needy community, they'll help you repay your loans.
If you're going to practice a specialty, then you will likely make enough money to sustain a good living AND pay your loans (like having 2 morgages). This doesn't sound ideal now, but it's very do-able.
Also, I think this decision depends on the kind of person you are. If you're the kind who obsesses abt a school and just can't get it out of your mind, then you should go with your gut abt where to attend (even if that's WV). You'll be most happy with your gut feeling at the end of the day.
On the other hand, if you someone who could be happy anywhere, and you're just kind of indesisive right now, then going with your gut might not be the best choice for you.
I also wanted to mention that $49K for tuition is very normal for most private M.D. schools (e.g. GWU, Georgetown, etc). If Georgetown accepted you, would you be complaining about the cost? If so, then go with the cheaper school. If not, then I'd say go with WVSOM. (WVSOM is not Georgetown, but your dream school is your dream school).
Hope that helps.