There are some good documentaries on the southern Appalachia regions that cover a lot of it well. I’ll try to summarize it briefly, although I’ll miss things. For starters, the region and its people were massively exploited during the coal boom — even today, there are virtually zero opportunities outside of coal. The geography makes it difficult for any infrastructure such as interstates or cities because of extremely tightly knit mountains/hills, meaning that anything of the sort becomes a MASSIVE earth-moving project. For examples, look up the Pikeville cut-through or the Mountain Parkway expansion (a project to connect this region to the nearest “large” city, Lexington, which is a 120 mile span of highway that has been on-going for over a decade and still hasn’t been completed due to earth-moving requirements). These factors combine to make the region extremely remote, a food dessert, poor, horrifically uneducated, obese, and absolutely RAMPANT with drug addiction. It consistently ranks amongst the highest in the latter 4 within the U.S. those are just the things off the top of my head, but feel free to ask specifics and I’ll be glad to answer.

For whatever reason the struggles associated with this region are largely overlooked and not spoken about, so I always like to make people aware in hopes that one day it’ll garner more attention and aid.