Piggybacking on your comment, not agreeing with the previous poster. Currently using all of the tooling you've mentioned on-premise and it's great! Using DNS A

Piggybacking on your comment, not agreeing with the previous poster. Currently using all of the tooling you've mentioned on-premise and it's great! Using DNS Anycast (cloudflare/akamai/insert provider) and LB technology we can get highly available without much work. We've got more 9's than our Azure production setups, sadly though I feel like Azure isn't a good standard to compare to. Bridging the gap from the cloud provider managed services to on-premise (colo) is actually relatively simple. By all means 95% of the tooling these providers use is Open source or has a major open source alternative. SMB world does change that to your point as I doubt you'll have a devops rockstar who can actually grok these things, more than likely you'll have a dinosaur MSP or IT guy. (for really small companies)