The key he says is going after local keywords for businesses that make a lot of money per client. The example he gives is Rhinoplasty Plano, TX. He says it doesn't matter how many searches a term has because he gets all the different variables of the search term.
This makes sense to me, but I do have a question which I left as a comment on the thread but he didn't answer, so I am asking you guys.
In order to keep making money from the high end business you have to provide leads not just rankings. Don't you need a good looking site with quite a bit of content (especially about the doctors) in order to get people to contact the business?
What I am saying is that a well ranked site that does not look professional will not provide leads to the business and as such will not make you money.
This is just a theory. Am I right? Also how hard/expensive is it to put together a professional looking site?