We live in a high COL area. We moved from a slightly less high COL area. (We live in San Francisco Bay Area now, moved from Seattle.) We're not in that top bracket but we're close. In this area, we couldn't pay for reasonable daycare on what I make in a year, which is why I'm a SAHM.
We do what we can to keep costs down. My car is a '98 Nissan - I'm the second owner. My husband drives a '06 Subaru because he has the commute and needs better gas milage. The Subaru is a must because we have dogs and needed the space to put them and baby in the car. We rent here, owned in Seattle. (The rent-or-own in Seattle was comparable, owning here is far, far more expensive than renting. We pay $2,200 for a 1600 sq ft 2 bed, 1 bath with a small yard for the dogs - the house next door sold earlier this year for $600,000 and the yard was been bricked-in to make a patio.) We don't eat out, don't go on trips, don't drive when it is not necessary (doctors and work). We have some other things we won't do, though, that raise our expenses. We won't shop at Wal-Mart, we eat organic as much as possible, we have food issues, and a lot of specific things we need to avoid. We get around this as much as possible by making things at home, shopping online for a better price or selection (I tell you, my Amazon Prime membership with free 2-day shipping has paid for itself several times over).
My husband and I both grew up poor. My mother was a schoolteacher and my father decided he didn't want to work after I was about 9 (my brothers were 2 and 4, so he wanted to be a SAHD - but sent them to daycare, too). We lived on my mother's Texas teacher's salary - which wasn't much. My father kicked me out really young (13) and then did what he could to take things from me. (For example; he cleaned out my bank account when I was 16. I had several thousand dollars in there from working really crappy jobs and had been saving up for college. When I asked the bank why they let him do it they said "Well, he had a copy of your birth certificate showing that he was your father." Last time I dealt with Wells Fargo.) So I started with nothing, repeatedly had my family clean me out and then it went from bad to worse - I married young to someone who lied and stole when he could. I worked three jobs to keep him in good health (diabetic that would rather buy pot than his insulin) and got out of that marriage with even less than I started it with. My husband has a similar back story - step father that collected SSI in his name and made him sign the checks, made him work and took the paychecks, made him buy his own food as a high school student, do laundry at a laundromat on his own dime, (edited to remove information; pm me if you need to discuss.) We're slowly getting things in order - debts paid off or down, life simplified. I've got to say, the best money-managing tool I've found is a partner with similar wants, desires and drives.
You bet I picked my husband based on his interest in earning money, shared values, debt management desires in addition to being handsome, sweet, funny and uh... some other things.
I chose my first husband based on "but I love him!" and didn't realize that he should have been someone I dated, realized we weren't compatible for cohabitation, stayed friends with and never married. It may sound very business-like to some people but running a house is a business!