State/regional bias in residency/fellowship/attending position

Wondering how this process works- is getting a residency heavily biased by what state/region you are from? How about fellowship? An attending position? I understand that there is bias if I apply to residency at my medical schools hospital or if I did research at the hospital I apply to, but beyond that, does location act as a significant limiting factor during these application processes? Wondering if it would be super difficult to match and/or work in a different state (not super competitive specialty) if I don’t have any professional connections there. Considering Washington state or Cali in the future. Cheers