70k is quite a differential; did you factor in interest? If not it could end up being quite a bit higher than that. It is my opinion, and the opinion of many others as well, that how you feel about the school itself (including the clinic) should be a far more important consideration than the city the school is in. Yes, the city definitely impacts the school (especially via the patient population) but if you would be equally happy with either school, and are just debating between living in Chicago vs. Memphis relative to 70k (or far more if that doesn't take into account expected interest payments on that extra 70k) then I personally would choose the less expensive option. I'm sure others will disagree with me, but yes, it really is worth it to save all that money! I'm not at all saying it should be your only consideration, and if you'd rather go to ICO because you like the school more (as opposed to just the city) I'd definitely weigh that. Obviously I ended up choosing an expensive school (PCO) but I did so for a number of reasons; I really like Philly, but the fact that I loved the school itself was by far the most important reason that I applied there. In making my final decision, the fact I liked Philly more was actually one of the tipping points for me (because both schools were great), although there were MANY factors I had to consider in my complicated situation. My expected cost differential wasn't remotely close to what you have to weigh (it was only around 5k per year, maybe a bit higher) so it didn't end up being too much of a consideration for me.