I pay them back asap with the rental cash flow and any extra cash I have sitting around from my W2.

In all, we were able to do a cash-out refinance after 1 year and got our entire investment, including down payment, back into our personal accounts and we still have a cash flowing property.The beauty of smaller town and communities is that often big-time investors are not looking at them as closely and they can cash flow quite well, at the sacrifice of "natural" appreciation.

Is it purely about the cash flow?

If it cash flows a little, great, but appreciation -- despite the skepticism on this site of that word -- is the real money-maker in real estate.

@Tacuma Bradley - Well, in general it's more difficult to rent out older places here, so there is such a constant flow of new property on the market. 

Each investor has his/her own goals combined with their own considerations for investment.

Cash flow would likely be a little higher and more marketable for a multi if prospective tenants feel like they have somewhere that’s their own, instead of just living in a room in someone else’s home.

I have a house very close to the Cleveland Clinic that I am thinking of doing this for extra cash flow.

I also rented my primary residence in Denver and have $800/mo cash flow on it.  

So the activity of the property will still be reported on their personal tax return where it is now.That is the important consideration.