1. Pay is absolutely terrible. Many people can earn more with another job straight out of college. There is a small ramp up period for both a recruiter and account manager for a few months. You really don't make money until you put a lot of people to work. Basically you get paid on something called your "spread" number which is a calculation that the company does to see how much you make off of a consultant's hours worked during a week. You only get paid when your contractor works. If they don't work (for whatever reason like a holiday, etc.), then you will not get paid. Most of the money is in temporary staffing and not in direct placements. You are always at the mercy of your accounts. If your accounts stops hiring or lays off your contractors due to budget cut backs then you will earn no commission money because your "spread" is low.
2. The account manager is a sales job and it is an absolute grind. I did it for 2 years. Some account managers (AM) get lucky by being given a nice established account that buys a lot of temporary staffing. Other AMs have to start from scratch and build a territory from nothing. This will require a lot of cold calling and relationship building. If you want to start with new accounts, it takes you easily a year or more to see success.
3. Lack of growth opportunities at a regional office. Basically the roles are Director, Account Managers, Recruiters and Customer Support Staff in an office. Unless you want to relocate to the headquarters, then there is a lack of career growth or opportunity.