People of Appalachia



  • Region:

    The term Appalachian came from the word Appalachee from the Appalachee Indians. The Appalachian Region is in the southeastern United States. It is the second largest mountain system of North America.The mountains stretch 1,500 miles and begin at the south easternmost tip of Canada, and end in Central Alabama. The region includes thousands of miles of hilly, forest terrain which attracted many timber harvesters. Also, 63,000 square miles of this region contains vast coalfields which once produced 2/3 of the nations coal supply.[2]
  • Early Settlers:

The earliest settlers to the Appalachian Mountain Region came in the early 1700s from Germany, England, and Scotland. Like many groups settling a new territory, the People of Appalachia came seeking new opportunities, land, and freedom. The higher quality costal regions were all occupied and over-populated, so the new settlers traveled west and settled in the Appalachian Mountains. The early settlers can be depicted as people who flourish by using outdoor material to supply all of there necessities. The typical Appalachian pioneer can be pictured wearing buckskin clothing, a rifle with buckskin strap, a raccoon tail hat, and a bull-horn used for a water canteen. No other famous man in history depicts this look more than Daniel Boone, one of the most well-known outdoorsmen of all time.
As early as the 18th century, Appalachia, known as the backcountry, began to distinguish itself from wealthier lowland and coastal neighbors to the east. Frontiersmen often bickered with lowland and tidewater "elites" over taxes, sometimes resulting in violent battles.
Settlers traveling to the Appalachian Region
Settlers traveling to the Appalachian Region

  • 20th Century Appalachian Settlers

      • The People of Appalachia grew into the stereotype of being a hillbilly and uneducated. It took multiple generations of these people to develop schools and efficient was of education. Education was never a primary thought among the pioneers of the region because the majority of the work they did was outside and children would learn through experience. Subjects such as mathematics, english, and science were not necessary to complete the hunting and gathering lifestyles of the late 1800s and early 1900s settlers.[3]
      • As new groups of people joined the People of Appalachia, the group as a whole began bringing religious beliefs into the society. The majority of the Appalachian occupants considered themselves as Christian (rooted from primary English settlers of the region) and believed in the values of the Commandments of the Bible.[3]
      • The People of Appalachia speak a dialect of Midland American English. The northern and southern regions slightly change the variation of this language.[1]
      • In the mid-1900s, many of the inhabitants of Appalachia lost their jobs. All the people who were timber harvesters and farmers were no longer employed. Poor farming techniques kill off much of the crop which ultimately doomed farmers. The government intervened and created multiple national forests which restricted timber harvesters from cutting down trees in much of the Appalachian Region.[3]

Poverty In Appalachia:

How Poverty Came About

  • In many situation, chronic poverty in rural areas represents long-term neglect and lack of investment. [8]
  • This lack of investment sometimes begins as deliberate efforts by those in power (local elites or employers) to hold people back so they don't have necessary power. [8]
  • In the Appalachian area, the coal operators wanted to restrain workers from unionizing and demanding better wages in coal mining because of high competition in the industry. [8]
  • The coal operators tried to control everything about workers' lives to keep their labor costs down. [8]
  • To control everything they kept people from being educated, controlled other stores and companies, and discouraged workers' participation in the community. They did all of this to make the workers dependent on the coal operators for everything. [8]
  • This same control and underinvestment took place in the Mississippi Delta and along the Mexico-U.S. border. It goes hand in hand with the history of slavery and sharecropping where the white plantation owners deliberately kept blacks from learning to read, owning property, or gaining skills that would give them freedom and the knowledge to make more choices. [8]
  • In the 1930s when Social Security emerged, Southern leaders could even keep farm workers and domestic servants from being covered by Social Security. With the small check, these leaders knew that their slaves could possibly support their families, which would change the labor marker in the South. [8]
  • The places we see persistent rural poverty are the places where there is a bad mix of economic control and racism.
  • Consistent rural poverty shows up on a the map in areas where people of color live, in addition to Appalachia (United States Department of Agriculture). [8]
  • Through this we can see that continuous poverty is not only an effect of individual bad behavior. We can see that this poverty is caused by the need for control. [8]
  • Today, the poor Americans are still dealing with underinvestment. Those in control are still keeping the isolated poor people from connecting with mainstream. Because of this, adults remain uneducated and powerless, leaving the young people unprepared to help in the future. [8]

Graph courtesy of:

Studies have shown that poverty rates increase as counties become more rural.


Relative Poverty Rates in Appalachia, 2005-2009

A poverty rate is the ratio of the persons below poverty level to the total number of persons for whom poverty status has been determined. The percent of the U.S. average is computed by dividing the county poverty rate by the national average and multiplying by 100. The map uses critical breaks such as the national average to organize the data into groups of common values. [6]


Poverty Statistics:

  • In the Appalachian area, more than 91 of the 410 counties are considered economically distressed by The Appalachian Regional Commission. [6]
  • "Distressed counties are defined as ones where poverty and unemployment rates are at least 150 percent of the national averages and where per capita market incomes that are no more than two-thirds of the national average." [6]
  • "Counties are also considered distressed if they have poverty rates that are at least twice the national average and they qualify on either the unemployment or income indicator." [6]
  • "The states with the most distressed counties are:
  1. Kentucky-35
  2. West Virginia- 21
  3. Mississippi- 12
  4. Tennessee- 8
  5. Ohio- 6
  6. Alabama- 5
  7. Virginia- 3
  8. North Carolina- 1" [6]

  • According to the 2008 US Census Bureau, Appalachia is home to 13.3 million people living in poverty. [9]
  • "On average, 20% of the people in the region live below the poverty line (the current national poverty rate for a family of four is $20,650 a year, i.e. $1,720 a month)." [5]
  • "In Eastern Kentucky, where 60% of counties are consistently poor, the A.T Massey company operated coal mines through 18 subsidiaries, and reported an operation profit in 2000 of $147 million with revenues of $1.1 billion." [5]
  • "In Hancock County, Tennessee the average income for a 4 member family is $14,000 a year, which is 47% of the national figure." [5]
  • "1/3 of all West Virginia's children are born into poverty" [5]

Occupations in the Appalachia Region:

    • The Appalachian area has a significantly lower amount of people within the workforce comparable to the rest of the United States. While fortunately the number employed between the ten year span of 1980 and 1990 did rise, it still remained beneath the rates throughout the rest of America. In 1980, the national average of American's in the labor force was 74.7% opposed to only 71.4% in the Appalachian region. This 3.3% difference rose to a 6.3% point range in 1990. In this same frame the female's employment rates in Appalachia rose 6.8 points, it still remained 5.6% points below the national average of 56.7%.Picture_1.png

  • Although this amount of difference is obviously significant, but even more noteworthy is the extreme rates of poverty and unemployment in the most distressed counties of the Appalachian region. The average in these areas is much lower than anywhere else in the fact that only 60.3% of males and 38.8% of women are in the labor force in these counties. [6]


Income and Wage Rates for Appalachia vs. National Average

  • While during the decade between 1980 and 1990 the unemployment rates did decrease signifying a hope for change for the future of Appalachia, the time period between 2000 and 2007 began to once again fall into the previous trends. The Appalachian people saw a loss of over 35,000 jobs or a decrease of 8.8% in all jobs relating to farming, forestry and natural resources. Due to the fact that the one major benefit of this region has always been the large influx of natural resources, this number is extremely telling of the current times. Along with the huge decrease in jobs relating to natural resources, Appalachia has also encountered a 22% decrease in manufacturing jobs during the same time frame, and unfortunately this area is assumed to lose even more jobs in the upcoming yearsprivate_employment_sectors.png.

  • As mentioned earlier the rates of unemployment are even more staggering because the majority of the middle to higher class individuals are condensed into specific areas causing a great deal of difference among regions in the Appalachia. For the most part unemployment is most severe in the western and southern points in the area. Compared to the rest of the U.S., 2/3rds of Appalachian counties have a higher rate of unemployment than the rest of the country.
  • Another problem rooted from the growing rates of unemployment is that a large proportion of the working-age people are beginning to leave the Appalachian region in hopes of more possibilities. The amount of people 65 or older in comparison to the rest of the population is now much larger than the rest of the United States, at 14.3% for the Appalachia compared to 12.4% for the rest of the country. [10]

Representations of the unemployment and economic status of the Appalachian region

  • Due to the fact that the counties within the Appalachian region are so diverse in terms of economic standings which is a prime indicator of higher and lower unemployment rates in certain areas. The best way to examine these differences is to look at a graph distinguishing between the individual counties and the amount of distress in the particular place:

  • County-Economic-Status_FY2010_Map.gifThis map displays individual counties in the mountains and if their economic standards on average are: distressed, at-risk, transitional, competitive or attainment. It helps to how incredibly diverse this region is in terms of their economic standings, which of course correlates a great deal with the occupational rates as well. Looking at this map you must take notice that this diversity is not taken account of in the statistics, but instead almost all of the information is taken as averages of the . The fact that there are many counties that have reasonably good economic standings proves just how distraught many of the other regions are to bring down the averages this much. Much like our entire nation, the Appalachian regions has a great deal of wealth inequality as well as very vastly unemployment rates for particular regions. With unemployment rates so far beneath the national averages shows just how distressed particular counties are to bring down the averages to this magnitude. [6]

Implications of Appalachia's Dominant Industry: Mining

On Health:

Based on a wide-range of factors, mining remains one of the dangerous jobs in our world today. There are of course the immediate risks of a collapse within the shaft and the possibility of becoming trapped, but there are also an immense amount of long-term risks as well. Respiratory problems are one such issue. Chronic bronchitis is a growing concern for people in the mining industry, and due to the fact that Appalachian people have a much lower rate of getting help for health problems this bronchitis usually grows into more serious issues. Up to 12% of coal miners suffer from the fatal diseases of Pneumoconiosis and Silicosis. Unfortunately the majority of the people within this industry are receiving a very dismal income and usually a limited amount of benefits. The Appalachian people are much less likely to go to doctors for what they believe are minute health problems, which can cause this chronic bronchitis to escalate into a fatal disease at a much faster rate. [13]
Along with the concerns related to the actual miners within such communities, it is also important to note the problems that develop in the people living around the mining industry. One of the largest issues that is rooted from the industry is the sedimentation the coal runs off into nearby streams. This pollution has proven to be the source of many health concerns within children, including: nausea, diarrhea, vomiting, and blue-baby syndrome. These things not only cause discomfort at the time but also are linked to much more serious health issues in the long-term, such as liver, kidney and spleen failure, bone cancers, and many digestive cancers. [12]

On the Environment:

Another huge implication relating to the mining industry in the Appalachian Mountains is its severe impact on the environment. Older than even the Himalayas, many would believe that there would be a strict enforcement for the beauty and preservation for this mountain range. Due to the fact that large coal distributions were found throughout this West-Virginia-Appalachia-mountains-being-mined-by-Mountain-Top-Removal.jpg area this no longer seems possible. Almost all coal mining in this region is done through mountaintop removal and realizing the fact that every 2 seconds in the United States 100 tons of coal are extracted, this is an incredibly troubling thought. In order for miners to get better access to this coal, huge bulldozers must be employed to tear down huge expanses of forests, topsoil and sandstone. This type of removal technique has massive repercussions on the ecology of the area. Flooding, mudslides, deforestation and the damaging of headwater streams all become prominent concerns with the utilization of mountaintop removal. [12]


And the Exploitation of its People:

Coal mining has always been a vital part of the economy throughout the Appalachian region. This area produces the second largest output of coal per year in the United States. Due to such a wide usage of coal for means of energy, this amount of production would seem like a very beneficial aspect to the economy through the mountains. Unfortunately even in its prime, the Appalachian people were receiving a very limited amount of the income coming from this resource. Many of the people were pushed off of their land in order to start mining operations and although this business brings in millions of dollars every year, little is going to the actual miners. This problem has became even worse in the past years with the process of mountaintop removal becoming the new main extractor of coal. Mountaintop removal is designed to incorporate machinery in order to lessen the human jobs necessary. An industry that once provided over 130,000 coal miners now is down to fewer than 20,000.
When the idea of coal mining was first brought into this region, the people were promised that this was the thing to take them out of their impoverished times, but instead it has done quite the opposite. From the beginning, they were pushed to sell their land very cheap in order tomake more room for the mining to take place and from there, the population made very little income on the industry despite past promises. Now the jobs within this sector are continually decreasing with the advancements in technology. Unfortunately these people which had place all of their hope in this industry in the past, do not seem to have any economic upturn in the near future. [11]

Health in Appalachia

  • People in Appalachia have greater rates for health problems than the national average of the continental United States. [15]
  • People of Appalachia experience high mortality rates, high proportions of smokers, obesity, and child poverty. They also experience poorer health status-- higher incidence of lung, colon, rectum, and cervical cancer in Appalachian region compared to other regions. [16]
  • "Most of Appalachia is rural. Of the 13 states with counties located in the Appalachian region, 10 states have Appalachian counties with lower population density than their respective state averages." [14] People of Appalachia have unequal access to healthcare as compared to those in the continental United States. Due to the geography of Appalachia, access to healthcare services is unattainable or much effort is required. Transportation is not easily attained when no car is owned.
  • "Access to cancer care is limited because of the region's history of a shortage of health care professionals and distance to referral centers from rural areas." [14] Another issue is the shortage of healthcare professionals in the Appalachian region, thus making it even harder for the population of the region to get proper health services.
Elkhorn City, KY - appalachia and poverty 4
Elkhorn City, KY - appalachia and poverty 4

Causes of Health Inequality

  • Cultural Values
    • A reason for inequality is Appalachian peoples lack of trust and "wanting to take care of their own"."We have identified communication between patients and health professionals as instrumental in creating either trust or distrust between individuals and families and health care professionals and the health care system. Trust is the critical factor in individuals' acceptance of information and use of health care services, including screening and treatment for cancer. Personal trust is hard to gain but, once gained, hard to lose in Appalachia." [14]
  • Lack of facilities
    • "Health service providers and facilities are unevenly distributed across the study area." [16] Lack of facilities close to living area of populations makes it hard for a person to acquire health services.
  • Socioeconomic Disadvantage
    • "A host of risk factors exist that make people more or less vulnerable to poor health: demographic characteristics (e.g., race/ethnicity, class, gender, sexual orientation, age, income, education), economic conditions (e.g., unemployment rates), environmental conditions (e.g., air and water quality), community resources (e.g., health and social services, housing), and public policies (e.g., qualification requirements for Medicaid benefits), to name a few." [15]
  • Mining
    • Due to the high amount of mining, people of Appalachia are at higher risks to deteriorate their health. Diseases of the heart, kidneys, and lungs may result from living and working in a mining community in Appalachia. [19]

Illustration of an appalachian tobacco barn in the winter Stock Photo - 4388034
Illustration of an appalachian tobacco barn in the winter Stock Photo - 4388034
Drug Abuse

  • There is evidence of prominent tobacco use in the Appalachian region. Evidence supports that there is "greater use of tobacco in Appalachian Ohio than in the rest of the United States, a finding that is unfortunately replicated across Appalachia." [14]
  • A large amount of tobacco crops are located in the Appalachian region. Many people are around tobacco products on a daily basis. Of primary care patients, 50% of them have a relationship with tobacco whether through use, sales, or production. [18]
  • With use of tobacco, risks to health are increased. "As such, they also suffer tobacco-attributable morbidity and mortality at significantly higher rates." Therefore through use of tobacco product and need for health care, inequality is experienced. [18]

Picture of Appalachian Tobacco barn


  • The National Health Institute deems Appalachia a region of priority in eliminating health disparities. [19]
  • More awareness to populations of the Appalachian region. Some examples of awareness are, "The aim of the first 'Faith Moves Mountains' intervention was to increase cervical cancer screening and prevention. Appalachia has a significantly higher incidence of cervical cancer than the United States as a whole. Even more troubling, the region has a 60 percent excess mortality rate for the disease, meaning that Appalachian women are 60 percent more likely to die from it." Because Appalachia is a close-knit population, sometimes it is hard to get the trust of the population. Therefore, "To facilitate the project, Schoenberg enlisted the help of what anthropologists call a 'cultural broker,' or somebody who is intimately connected to their own culture and has the ability and willingness to interpret it for outsiders to facilitate their movement within that culture." [20]
  • Also, there are prevention and activity programs to help alleviate the inequality of health in Appalachia." 'Healthy, Well-Thee and Wise' is an energy-balance program, designed to encourage healthy eating and physical activity. 'Quittin’ and Preventin’' is a cancer-prevention program that incorporates smoking cessation and cancer screening."
  • Appalachian Regional Commission (ARC) [17]
    • An ARC health grant provided the Appalachian region with medical equipment for hospitals and rural clinics, training for health care professionals, and support for community-based health education activities.
    • J-1 Visa Waivers- Foreign-trained physicians doing residency work in the United States would be subject to a J-1 Visa Waiver, which required these physicians to practice for at least three years in rural Appalachia due to the low amount of medical professionals in the area.
    • Develop highway system to decrease isolation.

Education in the Appalachian Mountains:Appalachia6.jpg


The region of Appalachia has been behind the rest of the United States in education for many years. This is due to lack of funding from the state governments and the fact that many people inhabiting Appalachia do not see a need for formal education. In earlier years children were to only attend school when they were not needed to help out around home, whether they were involved in farming or housework, depending on whether they were a boy or girl. Mandatory education laws were issued after the Civil War and grade schools and high schools were established. Religion plays an important role in education in the Appalachia’s, where teaching the theory of evolution is debated. In the 21ST century the Appalachian people have struggled with loss of funding because they are unable able to fulfill the law of No Child Left Behind, which was instated in 2001. [22]

No Child Left Behind was proposed by George W. Bush at the time of his presidency. The policy seeks at funding schools that are measuring up to high standards of education. Assessments are given to students of all grades to test them on their knowledge. If the school meets regulations, they will receive funding. Those schools that to do not meet the standards are unable to receive funding because of the lack of education they are teaching their students, which are causing them to score lower. [23]

Barriers of Education
  • Economic Issues:
    • Direct college costs rising, including the cost of tuition, books, whether or not a family it able to obtain financial aid or scholarships
  • Traditional Family Attitudes:
    • Idea that women belong in the house to understand food production and other household duties
    • Parents fear of losing children to the world if they go out and get a degree
  • Lack of Parent's Education:
    • Parents of Appalachian children may not be supportive because they were not able to obtain a degree themselves, so there becomes a lack of motivation to obtain one themselves
  • Overall Poverty:
    • Very prevalent in urban areas where educational attainment is much lower [21]

Educational Attainment Levels

People of Appalachia have historically been behind everyone else in the United States in social and economic well-being. Poverty and unemployment reflect on their poorer education and the fact that there are a minimal amount of jobs available that require a higher level of skill. This chart illustrates Educational Attainment in Appalachia and the United States. On the X-axis, it has the years for when the information was obtained and the percent change in the years for both Appalachia and the U.S. On the Y-axis, you can see the differences between dropouts up to college graduates. [24]

In 1980-1990, the region of Appalachia experienced an increase of educational attainment. In the 1980s, 42% of residents aged 25 or older had not completed high school. You can see that this has decreased since then and was reported in the 1990s, that only about 32 % of people 25 years or older had dropped out. You can also see in this chart, that that there is an increased amount of people who are at least attending some college and even graduating college. As a result, educational levels in Appalachia were beginning to look more like the U.S. [24]

Educational Differences Between Gender, Race, and Age

In the Appalachian region, white men and women graduate with higher levels of education than do any other race. African American and Hispanics are much more disadvantaged and often find their selves going into the labor force after dropping out of high school. Hispanics have been found to achieve a higher education than African Americans, but still not at the rate that white men and women do.
In the charts below you can see how educational attainment levels vary by gender, race, and age for the year of 1990. The graph shows that Black Women have some of the highest percentages for having less than a high school degree followed by Hispanic women and then white women. Depending on the age, you can see that African American men and Hispanic men are close in percentages throughout educational attainment levels. They are significantly lower than white men. You also are able to see a relationship between the age of people living in Appalachia and their educational attainment levels. It seems that no matter what your race or gender is, people aged 65 and older have much higher rates of not having degrees than the younger people of Appalachia. Overall when looking at gender differences, it seems that women are less likely to obtain levels of schooling than men. [24]



Educational Differences Across Regions of Appalachia

Next we can look at the educational attainment levels across the regions of Appalachia. You can see with this chart that it shows the changes between the years of 1980 and 1990. North Appalachia seems to have the lowest educational attainment compared to the other regions. South Appalachia on the other hand has experienced some of the biggest increases in attainment while Central Appalachia continues to be below both North and South in completing schooling. Along with regions of Appalachia that show poorer educational attainment there is a link with rural counties having poorer attainment within those regions. They have been known to have the lowest population in college. [24]


Educational Attainment and Economic Distress

There is also a link between the amount of economic distress a person or a family might have and their educational attainment level in Appalachia. As you can see in the chart below, people who are most distressed are obtaining less schooling than those who are not. Because Appalachia is a region of poverty and continued economic struggle, it is hard to obtain an education when people are looking for jobs to support themselves. It has been shown that receiving an education, during the absence of jobs is unable to improve the situation Appalachia is in, in terms of economic well-being. [24]


Getting Past the Inequalities:
"1. Increase job opportunities and per capita income in Appalachia to reach parity with the nation.
  • Develop leaders and community capacity
  • Diversify the economic base
  • Enhance entrepreneurial activity in the region
  • Develop and market strategic assets for local economies
  • Increase the domestic and global competitiveness of the existing economic base
  • Foster the development and use of innovative technologies
  • Capitalize on the economic potential of the Appalachian Development Highway System
  • Encourage sustainable economic use of natural resources
  • Encourage investments in energy projects that create jobs

2. Strengthen the capacity of the people of appalachia to compete in the global economy

  • Develop leaders and strengthen community capacitySchoolKids2704_468x322.jpg
  • Enhance workforce skills through training and education
  • Increase access to quality child care and early childhood education
  • Increase educational attainment and achievement
  • Expand community-based wellness and disease-prevention efforts
  • Increase availability of affordable, high-quality health care

3. Develop and Appalachia's infrastructure to make the region economically competitive

  • Develop leaders and strengthen community capacity
  • Build and enhance basic infrastructure
  • Increase access to and use of telecommunications technology
  • Preserve and enhance environmental assets
  • Promote the development of an intermodal transportation network

4. Build the Appalachian Development Highway System to reduce Appalachia's Isolation

  • Develop leaders and strengthen community capacity
  • Promote the successful development of the ADHS
  • Improve planning to enhance multi-jurisdictional coordination and efficiency
  • Encourage intermodal coordination
  • Enhance the energy efficiency of the transportation system
  • Develop a transportation system that enhances and preserves the region's environmental quality" [6]


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[2] "Appalachian Mountains - New World Encyclopedia." Info:Main Page - New World Encyclopedia. Web. 12 Dec. 2011. <>.

[3] "Appalachian Mountains Facts and History - Life in the Appalachian Mountains of North Carolina & Tennessee." Asheville North Carolina Tourism - Asheville NC Hotels, Attractions and Local Businesses. Web. 08 Dec. 2011. <>.

[4] "Our Forefathers, The Early Settlers of Appalachia | GA Mountain Land." Georgia Mountain Land News for Buyers, Sellers, Lenders, Inspectors. Web. 12 Dec. 2011. <>.


[5] "About Central Appalachia." The Appalachian Community Fund. Web. 26 Oct. 2011. <>.

[6] Appalachian Regional Commission. "Moving Appalachia Forward." Appalachian Regional Commission Strategic Plan (2010). ARC. Web. 02 Nov. 2011. <>.

[7] "ERS/USDA Publications." USDA Economic Research Service - Home Page. Web. 19 Oct. 2011. <>.

[8] "Readings - Why Poverty Persists In Appalachia | Country Boys | FRONTLINE | PBS." PBS: Public Broadcasting Service. Web. 24 Oct. 2011. <

[9] Ziliak, James P. "Human Capital and the Challenge of Persistent Poverty in Appalachia." Federal Reserve Bank of Cleveland. Web. 02 Nov. 2011. <>

[10] Carrozza, Mark A. "Appalachian Economic Status Data." HealthLandscape. 5 Jan. 2009. Web. 13 Oct. 2011. <>.

[11] "Impacts of Coal 101: Mountaintop Removal = Job Removal « Appalachian Voices." Appalachian Voices. 21 Jan. 2011. Web. 22 Oct. 2011. <>.

[12] Reece, By Erik. "Mountaintop-removal Mining Is Devastating Appalachia, but Residents Are Fighting Back | Poverty & the Environment: On the Intersection of Economic and Ecological Survival | Grist." Grist | Environmental News, Commentary, Advice. 16 Feb. 2006. Web. 10 Nov. 2011. <>.

[13] Stephens, Carolyn, and Mike Ahearn. "Worker and Community Health Impacts Related to Mining Operations Internationally." Mining, Minerals, and Sustainable Development. Nov. 2001. Web. 25 Dec. 2011. <>.


[14] Behringer, Bruce. "Appalachia: Where Place Matters in Health." PubMed Central. 15 Sept. 2006. Web. 08 Dec. 2011. <>.
[15] Gravois, Renee L. "Uneasy Tensions In Health Care Delivery In A Rural Appalachian Coal Mining Community: Envisioning Alternative Solutions." UIowa Libraries. Web. 25 Oct. 2011. <>.

[16] Hare, Timothy S. "The Impact of Health Service Availability and Accessibility on Health Outcomes in Central Appalachia." Print.Hautala, Keith. "UK Center for Excellence in Rural Health-Hazard." University of Kentucky | Medical Center. Web. 5 Nov. 2011. <>.

[17] Home - Appalachian Regional Commission. Web. 1 Dec. 2011. <>.
[18] Wewers, Mary E. "Risky Behaviors Among Ohio Appalachian Adults." PubMed Central. 15 Sept. 2006. Web. 5 Dec. 2011. <>.
[19] Hendryx, Michael. "Poverty and Mortality Disparities in Central Appalachia: Mountaintop Mining and Environmental Justice." Journal of Health Disparities Research and Practice 4.3 (2011): 44-53. Web. 16 Nov. 2011. <>.

[20] Hautala, Keith. "UK Center for Excellence in Rural Health-Hazard." University of Kentucky | Medical Center. Web. 5 Nov. 2011. <>.


[21] Addington, James R. "Education and Development in Rural Appalachia: An Environmental Education Perspective." 11 Mar. 2011. Web. 12 Nov. 2011. <>.

[22] "Appalachia." Wikipedia, the Free Encyclopedia. Web. 30 Oct. 2011. <>.

[23] "No Child Left Behind Act." Wikipedia, the Free Encyclopedia. Web. 30 Oct. 2011.
[24] McLaughlin, Diane, Dan Lichter, and Stephan Matthews. "Demographic Diversity and Economic Change in Appalachia." (1999): 1-288. Web. 1 Nov. 2011. <>.