I notice that Japan seems to be more into making their RPGs take place in the modern day or have modern elements to them. Persona is like this (though that's more supernatural/horror than fantasy) and FF7 was really groundbreaking in making a world that somehow mixed the modern and even futuristic aspects of fiction with traditional fantasy. Even outside of RPGs you have stuff like Blazblue that creates a dense world of technological prowess and marries it to magic. This time of genre is also all the rage in Japan nowadays, perhaps being popularized by visual novel writer Kinoko Nasu (Fate/Stay Night, Tsukihime, and The Garden of Sinners), though it has been around longer than that.
I don't get why the West would shy from this. I mean, it's the whole point of Harry Potter and a lot of imitators of it trying to replicate its success (though HP didn't really delve into marrying the two that much, perhaps only making Harry a fish out of water in order to do exposition without it seeming out of place). You'd think some developer would try to do an RPG where you were in the real world or at least one almost exactly like our own and then adding a world of magic previously unknown to the world. It would make a great juxtaposition and you could even do some interesting commentary. Oneo f the few Western games I can think of that does that is the Vampire: The Masquerade RPG (but again, more horror/supernatural than fantasy). It really does show that devs really need to mix up RPGs and get them out of the tropes Tolkien set up (and while they're at it, also stop copying George R.R. Martin because Game of Thrones has taken off). It could really give the genre a much-needed boost in creativity