The Keyword Economics of an Underpriced Market

Somewhere in Florida this month, a dermatology practice is paying Google roughly $25 every time someone clicks an ad for "dermatology digital marketing." Another practice, searching for a "medical spa SEO company," is generating clicks that cost advertisers $25 apiece. Meanwhile, the organic difficulty score for both of those exact phrases, the number that estimates how hard it is to rank in the top 10 without paying for a single click, is 0 out of 100.

That gap, between what an industry is willing to pay for attention and how hard it actually is to earn that attention for free, is one of the most useful signals in marketing. Most founders never look at it. They pick a market because they know someone in it, because they had a bad experience with a bad vendor in it, or because a conference talk made it sound exciting. All reasonable starting points. None of them tell you whether the market is actually underpriced.

This year, Key Twenty expanded from pure startup go-to-market work into a new vertical: medical aesthetics, med spas, dermatology groups, and injectors. We didn't get there on a hunch. We got there by running the numbers, the same numbers any founder can pull before committing to a niche, a channel, or an ICP. Here's the framework, and the actual data behind the decision.

The Problem With Picking a Market on a Hunch

"Go-to-market strategy" is one of the most written-about topics in startup content, and one of the least searched-for. Ahrefs puts U.S. search volume for the exact phrase "startup go-to-market strategy" at 20 per month. Twenty. Nationally. Compare that to "go to market strategy template" (600 searches a month, difficulty 0) or "startup marketing strategy" (350 searches a month, difficulty 15, average CPC $0.70). The category is real but small, and cheap: nobody is paying much to acquire a click on it, which usually means nobody thinks it converts to much revenue on the other end.

That's not a knock on GTM content. It's a reminder that search demand and commercial intent are two different things, and the gap between them is exactly where opportunity hides or doesn't.

Three Numbers That Tell You If a Market Is Underpriced

Before picking a vertical, a channel, or even a single content topic, we run three numbers. All three come from standard keyword research tools (we use Ahrefs); none of this requires proprietary data.

Search volume tells you if anyone is actually looking. Low volume caps your ceiling no matter how attractive the economics look.

Keyword difficulty estimates how hard it is to rank in the organic top 10 for a term, on a 0 to 100 scale, based on the strength of the sites currently occupying those spots.

CPC, cost per click, is what advertisers are currently paying Google for that same intent. It's a real-money proxy for how much a click is worth to the businesses bidding on it.

Individually, none of these numbers means much. Together, they tell a story. High CPC paired with high difficulty means a market everyone has already priced correctly, expensive to win by any method. High CPC paired with low difficulty means a market where buyers have decided the traffic is worth serious money, but almost nobody has bothered to compete for it organically. That mismatch is the signal. It means the paid channel is propping up demand that the organic channel hasn't caught up to yet, and whoever shows up with real content and a real site gets to collect a check that everyone else is currently writing to Google instead.

A Live Example: What the Data Said About Medical Aesthetics

Here's the side-by-side. Both tables use U.S. monthly search volume, Ahrefs Keyword Difficulty (0 to 100), and average CPC, pulled in September 2026.

Startup / general GTM terms

Medical aesthetics / med spa / dermatology terms

Look at the pattern. Nearly every high-intent term in the aesthetics cluster carries a CPC in the $9 to $25 range, five to forty times what the equivalent startup marketing terms command, and a meaningful share of them sit at a difficulty score of 0 or close to it. "Plastic surgery marketing" alone gets 1,400 searches a month at a $10 CPC and a difficulty of 0. That is a keyword an industry is actively paying to reach, that almost nobody has built real content to earn for free.

The clearest single number in the dataset: "medical spa SEO company," 500 searches a month, a difficulty score of 0, and a $25 average cost per click. Practices are paying top dollar for clicks on a phrase that, organically, is essentially unclaimed.

Worth noting: the mismatch isn't uniform across every term in the cluster. "Med spa marketing agency" and "medspa marketing agency," the phrases someone types when they're already shopping for a vendor, sit at difficulty 34 and 35. Those are contested, because every marketing agency that serves this space, including us, is competing to rank for them. The gap lives in the terms one step earlier in the buyer's search: the educational, practitioner-facing, "how do I think about this" phrases. That's usually where it lives. Bottom-of-funnel "hire someone" terms get fought over first. The terms just above them, where a buyer is still forming the question, are where the real estate sits open the longest.

Who's Actually Winning These Rankings Right Now

Difficulty scores are an estimate. The more convincing evidence is looking at who's actually sitting in the search results today. We pulled the live top 10 for two of these terms.

For "med spa SEO" (500 searches/month, $16 CPC), the number two organic result is a domain with an Ahrefs Domain Rating of 21, a site with a relatively thin backlink profile, outranking pages from domains rated 73, 82, and 83. In most competitive B2B categories, a DR 21 site doesn't get near page one against that kind of authority. Here it does, because nobody with real authority has built a page good enough to hold the position.

For "plastic surgery marketing" (1,400 searches/month, $10 CPC, the highest-volume term in the whole cluster), position four is held by a domain with an Ahrefs Domain Rating of 0. Brand new. No backlink history to speak of. Sitting on page one for the single biggest keyword in the category, ahead of domains rated 30, 55, 66, and 91.

That's not a fluke. It's what a market looks like before the content investment has caught up to the ad spend. The paid channel has already told everyone in this industry that the traffic is valuable. The organic channel just hasn't been built out enough to make anyone fight for it yet.

Why This Matters Beyond Med Spas

The point isn't that every founder should go start a med spa marketing agency. It's that this is a repeatable, five-minute check you can run on any vertical, channel, or ICP you're considering, before you commit six months of runway to it.

1. Pull the core terms for your buyer's problem, not your product. Not "our category name," the phrases your actual buyer types into Google when they're trying to solve the problem you solve.
2. Compare CPC to keyword difficulty across the cluster, not just one term. One outlier keyword doesn't make a market. A pattern across fifteen or twenty related terms does.
3. Check who's actually ranking. Difficulty scores are a model. Domain Rating and traffic on the current top 10 tell you whether the model matches reality, and whether the incumbents are serious operators or accidental winners.
4. Read the intent, not just the volume. A keyword with commercial or transactional intent (someone looking to buy or hire) and a CPC/difficulty mismatch is worth far more than a high-volume informational term with the same gap.

A market that clears all four checks is a market where the hardest, most expensive part, proving people will pay, has already been done for you by every advertiser currently bidding on it. Your job is just to show up with something better than what's on page one right now, which, as the data above shows, is often a surprisingly low bar.

Where This Method Breaks Down

Worth being honest about the limits. A high CPC doesn't automatically mean a lucrative market, it can also mean a handful of desperate advertisers bidding each other up in a small, thin auction with almost no real buyers behind it. A difficulty score of 0 can mean genuine white space, or it can mean the tool simply hasn't seen enough ranking history to score the term with confidence. And none of this tells you whether the audience behind the keyword is a market you actually want: profitable to service, reachable by more than search, and durable past the next algorithm update.

Treat this as a filter, not a verdict. It's the fastest way to cut a long list of "maybe" markets down to a short list worth a real look, not a replacement for talking to the actual buyers in that market. We still did both before committing.

What We Did With This

We ran this exact exercise across several categories before deciding where to put Key Twenty's next quarter of effort. Medical aesthetics wasn't the only category with a gap, but it had the clearest, most consistent CPC-to-difficulty mismatch of anything we looked at, and the SERPs confirmed it: real practices spending real money on ads, and page one held together by a mix of thin sites and a handful of strong but generic industry publications, not by dedicated, well-built competitors.

That's the version of "market opportunity" we trust: not a hunch, not a trend piece, a measurable gap between what an industry is paying for attention and how hard that attention actually is to earn. It's the same check we now run for every startup client sizing a new niche, a new region, or a new ICP before they spend a dollar on it.

If you're weighing a new market, a new vertical, or a pivot, run these numbers before you run the plan. It takes less time than a single strategy meeting, and it will tell you more than the meeting will.

Want a second pair of eyes on the math for your own category? Get in touch with Key Twenty.

Keyword volume, Keyword Difficulty, and CPC data sourced from Ahrefs, U.S. search data, September 2026.