This is just me, but I wouldn't do it. If I didn't already have a job possibly, if we were absolutely drowning financially, but otherwise, no, it's not worth it. For one thing, you said the pay is low and the COL is high, so it would definitely set you back financially, since you would have to find a place to live for yourself in the small town in addition to the cost of paying for where you and your husband currently live. Then, of course, there's the even more important consideration of what it would do to your marriage if you and your dh lived far apart for a couple of years. Assuming you love him and want to stay married, that would put a great strain on your relationship that just wouldn't remotely be worth it for me. Besides, if the goal in doing this would be to get acute care experience and then move back home and try to find something more local, what if no jobs ever presented themselves in your hometown, even in a year or two? Would you continue to live far away from your husband to work in acute care indefinitely, even if it turned into four or five years?
I have worked both inpatient acute care and home health (well, home hospice, which is similar). I see so many threads here on AN about how people are so desperate to get into acute care and I always wonder why. I guess that if you haven't ever worked acute care you would want to try it, but for me, acute care is stressful and much less desirable than being out in the field. I will never go back to acute care again unless we are starving. No autonomy, long hours on your feet, cranky supervisors, complaining co-workers, working both days every other weekend...nope, never again.
I feel for you, it must be frustrating, as it is for a lot of people right now, and only you and your husband can make a decision this big and potentially life changing, but for me? Nope, no way, not worth it.