I think an investor can find a nice property there that will cash flow and potentially appreciate.My issue is that the OP mentions that she disqualified Baltimore because the city had a declining population but was still considering Cleveland and Toledo.From my brief research Cincinnati and Columbus both have had population increases.

So its either all cash, findings those needle-in-a-haystack lenders, or would need to be some other creative structure

Hi Max, I can speak about the Columbus Ohio market (as this is the market I specialize in) but yes, there is strong competition here and there are obviously some cash buyers and they will always have a slight advantage.

We are not too strapped for cash, but it always seems better to have more in the bank than less.

In terms of my goals, I concentrate/focus on three metrics (and cash flow isn't one of them because that can be manipulated). 

A cash-flowing, large lot, alley loaded duplex that needed a new roof, painted and new floors.

It's the cash you put in that's your cost for the property. 

Cash Payment: Decide whether you'll finance the purchase or pay in full.Future Resale Value: Factor in potential appreciation of the property.2.

The cash flow is a bit sub par on this one and I anticipate some larger expenditures coming my way in a year or two so I'm contemplating this as an option.

It's a more affordable market and lower property taxes, so you may actually have a chance to cash flow.