“It was a big investment for the college,” said Alan Murdock , Forsyth’s vice president for economic and work force development. Another offering is a cybersecurity training program. And Forsyth is setting up a center at a small local airport to train workers in aerospace technologies, potentially seeding a drone industry.

While Winston-Salem lacks many of the amenities Amazon was seeking, city leaders claim it has plenty of selling points: a low cost of living, a lively downtown and uncongested streets among them. The sources of venture capital are more limited than in California, but the investment goes further. And there is a greater opportunity to stand out.

At the Institute for Regenerative Medicine, researchers have created skin and cartilage, urethras and bladders. I saw an artificial heart valve, opening and closing, made from human cells. Dr. Atala hopes one day to build complex, solid organs like kidneys or livers.

“One concern I had was whether we would be able to recruit talent as well here as we could in Boston,” he said. “Truth is we can recruit better.” Twenty people joined Dr. Atala in his move to Winston-Salem. Now his institute employs some 450, heavy on Ph.D.s.

Other tech entrepreneurs have settled in Winston-Salem. David Mounts considered Atlanta and Dallas before deciding to put the headquarters for his tech services company, Inmar, in the Innovation Quarter, where 900 of its 4,500 employees work. “It is easier to create innovation consortia between businesses, academia and government in a small city that understands innovation as a team sport,” he told me. In big cities, he said, there are simply too many parties with divergent interests.

But Mr. Mounts also recognizes the challenge. Everybody has to pull together. As Mayor Allen Joines said, “We have no choice.”