The region described—stretching southwest from Pennsylvania through West Virginia, Kentucky, Tennessee, and into Alabama—is Appalachia (specifically, the central and southern subregions of the Appalachian Mountains).
Defined by the Appalachian Regional Commission (ARC): 423 counties across 13 states (NY to MS). The "core" described spans the Central Appalachians (PA, WV, KY, TN) and Southern Appalachians (northern AL, GA, SC).
Resource extraction economy: Coal, timber, gas—wealth exported, little local reinvestment. Company towns, scrip payment, miner dependency.
Topographic isolation: Steep terrain limited transportation, industrial diversification, education access.
Political marginalization: Rural overrepresentation in state legislatures diluted by urban dominance; federal neglect until 1960s War on Poverty.
Health disparities: Black lung, opioid crisis, food deserts, provider shortages—lowest life expectancy in US.
Bluegrass/old-time music, storytelling, crafts (quilting, woodworking), distinct dialects, strong kinship/church networks. Not merely "poor"—a distinct cultural region with deep resilience.
Coal decline (automation, competition, regulation) accelerated outmigration. Broadband gaps hinder remote work. ARC investments target entrepreneurship, tourism (outdoor recreation), healthcare, education. Some "brain gain" in amenity-rich towns (Asheville, Boone, Abingdon).