There are a lot of programs that aren't CHOP, Boston, TCH, etc but have excellent reputations. The term "diamond in the rough" might connotate some negative "patina" to the program for one reason or another though. One program that I had experience with as a 4th year med student (rotating in some subspecialties) was Maine Medical Center in Portland. MMC is a great hospital, very technologically adept. The program is medium sized but sees lots of variety in pathology. Robust sub-specialty services (including peds CT surg). When I rotated through it had a tremendous reputation for being friendly. Portland is a fantastic city as well. I got the impression that all this made the program somewhat competetive, so definitely one you had to rotate through to get a spot. I know of no negatives associated with the program, though some may not appreciate Maine winters.