Not familiar with Wayne. I have some knowledge of Virginia Tech from a friend of mine. PBL is a big part of the pre-clinical learning there. I can't speak for an entire class/school, but the input I have heard has been very favorable. Students like the collaboration but there is a fair amount of work associated with it. I'm told that after each case the actual patient (or similar patient) comes in at the end of the week to discuss the case and their experience with the students. Virginia Tech (VTC) does require a lot of "in class" hours each week so that's something to consider. Some people like the engagement, some feel it's too much.
I think the small class size is a huge plus. Access to faculty, mentoring, no fighting for opportunities, one-on-one help when needed especially for ERAS preparation. I doubt you'll have issues finding people you vibe with unless you are truly "different."
Roanoke is what I would call a small city, definitely not a town. Maybe 100,000 residents and at least double that in the metro area. It does get rural as you head out of town in all directions. It's got a nice downtown vibe though.
The mandatory research requirement is something to think about. If you're really into research, VTC makes sense.
To me, the cost might be the biggest factor. VTC tuition is lower and cost of living is pretty low. As you say, weather is better too.
If you are comfortable with PBL and want to do consequential research, I think VTC is a great choice.