There
 are many tough places in this country: the ghost cities of Detroit, 
Camden and Gary, the sunbaked misery of inland California and the 
isolated reservations where Native American communities were left to 
struggle. But in its persistent poverty, Eastern Kentucky — land of 
storybook hills and drawls  — just might be the hardest place to live 
in the United States. Statistically speaking.
The team at The Upshot,
 a Times news and data-analysis venture, compiled six basic metrics to 
give a picture of the quality and longevity of life in each county of 
the nation: educational attainment, household income, jobless rate, 
disability rate, life expectancy and obesity rate. Weighting each 
equally, six counties in eastern Kentucky’s coal country (Breathitt, 
Clay, Jackson, Lee, Leslie and Magoffin) rank among the bottom 10.
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| Mother Jones giving children shoes. Paint Creek | 
Clay
 County, in dead last, might as well be in a different country. The 
median household income there is barely above the poverty line, at 
$22,296, and is just over half the nationwide median. Only 7.4 percent 
of the population has a bachelor’s degree or higher. The unemployment 
rate is 12.7 percent. The disability rate is nearly as high, at 11.7 
percent. (Nationwide, that figure is 1.3 percent.) Life expectancy is 
six years shorter than average. Perhaps related, nearly half of Clay 
County is obese.
It’s
 coal country, but perhaps in name only. In the first quarter of this 
year, just 54 people were employed in coal mining in Clay County, a 
precipitous drop from its coal-production peak in 1980. That year, about
 2.5 million tons of coal were taken out of the ground in Clay; this 
year, the county has produced a fraction of that — just over 38,000 
tons. Former mines have been reclaimed, and that land has been 
repurposed in scattershot ways: a golf course, shopping centers, a 
medium-security federal prison. But nothing has truly come to replace 
the industry on which Clay County once depended.
The
 public debate about the haves and the have-nots tends to focus on the 1
 percent, especially on the astonishing, breakaway wealth in cities like
 New York, San Francisco and Washington and the great disparities 
contained therein. But what has happened in the smudge of the country 
between New Orleans and Pittsburgh — the Deep South and Appalachia — is 
in many ways as remarkable as what has happened in affluent cities. In 
some places, decades of growth have failed to raise incomes, and of 
late, poverty has become more concentrated not in urban areas but in 
rural ones.
Despite
 this, rural poverty is largely shunted aside in the conversation about 
inequality, much in the way rural areas have been left behind by broader
 shifts in the economy. The sheer intractability of rural poverty raises
 uncomfortable questions about how to fix it, or to what extent it is 
even fixable.
The
 desperation in coal country is hard to square with the beauty of the 
place — the densely flocked hills peppered with tiny towns. It’s 
magical. But it is also poor, even if economic growth and the federal 
safety-net programs have drastically improved what that poverty looks 
like.
Fifty
 years ago, President Lyndon B. Johnson declared his “war on poverty” 
from a doorstep in the tiny Kentucky town of Inez, and since then, 
Washington has directed trillions of dollars to such communities in the 
form of cash assistance, food stamps, Medicaid and tax incentives for 
development.
 (In some places, these transfer payments make up half of 
all income.) Still, after adjusting for inflation, median income was 
higher in Clay County in 1979 than it is now, even though the American 
economy has more than doubled in size.
There
 have been periodic attempts to flood persistently poor counties with 
federal dollars in an effort to jolt them into higher growth rates. The 
Obama administration this year named southeastern Kentucky a “promise 
zone,” putting it at the top of the list for federal grants. It’s an old
 idea: Draw in businesses, create jobs, help finance infrastructure, 
turn the cycle virtuous.
On
 the opposite end of the ideological spectrum, Kentucky’s libertarian 
senator, Rand Paul, has proposed a more supply-side-oriented strategy: 
Let certain counties eliminate capital-gains taxes and institute a 
special federal income tax of 5 percent in those areas. “I’m just 
letting you keep more of your own money,” Paul said to a small crowd in a
 college auditorium in eastern Kentucky last winter. “The difference 
between this and a government grant is I don’t choose who gets it.” On 
either side of the aisle, the underlying assumption is the same: Places 
like Clay County just need a kick-start. But what if that isn’t true?
In
 many cases, a primary problem in poor rural areas is the very fact that
 they’re rural — remote, miles from major highways and plagued by 
substandard infrastructure. Think about the advantages of urban areas, 
described by thinkers going back to Jane Jacobs and beyond. Density 
means more workers to choose from, more potential customers, more 
spillover knowledge from nearby companies. As such, cities punch above 
their weight, economically speaking. The 10 largest metro regions 
produced more than a third of the country’s entire economic output as of
 2012.
The
 converse is true for rural areas. Take eastern Kentucky, grappling with
 the decline of coal — and perhaps looking at an even bleaker future for
 the industry, given recent carbon-reduction efforts by the E.P.A. Those
 rolling hills might be picturesque. But those country roads make it 
hard to ship goods in and out, in turn making it more expensive to build
 a warehouse or a factory.
“One
 of the challenges that faces eastern Kentucky is the remoteness of the 
area,” said James P. Ziliak, the director of the Center for Poverty 
Research at the University of Kentucky. “It’s difficult to get to a lot 
of places.
The communities are small, and they’re spread apart, so you 
lose that synergy that you want to spark development a lot of times.” 
Even with additional government subsidies, would businesses really want 
to move there? “It’s this chicken-and-egg problem,” Ziliak said. “My 
view is that firms will never locate into a community with an unskilled 
labor force, unless the only labor they need is unskilled. And there has
 been a historic lack of investment in human capital in these areas.”
The
 queasy answer that economists come to is that it would be better to 
help the people than the place — in some cases, helping people leave the
 place. Generally, the wealthier and better educated the family, the 
more mobile they are. It takes resources to pack up all your things, 
sign a new lease, pay for gas or a flight and go. That might help 
explain why more Americans aren’t flocking from places with high 
unemployment rates to places with low ones, even if those places are 
surprisingly close together. College graduates, for instance, are 
several times as responsive to differences in labor demand as those who 
completed only high school, according to a study in The Journal of Human
 Resources.
But
 government policy based less on place and more on people might help 
ameliorate that trend. “Let’s say I was a hardworking person who lost my
 job in Harlan, Ky. — the ideal place, really, to go is Williston, 
N.D.,” Senator Paul said. “People need to be mobile to go there. Some 
government programs prevent mobility or discourage mobility.” And none 
encourage it: There are scant federal resources to help the unemployed 
or the poor in rural areas move to a job or even just a better 
neighborhood. (Imagine Senator Mitch McConnell running for re-election 
on the campaign slogan: “I’ll get you out of this moribund area and up 
to the wilderness of North Dakota!”)
Of
 course, thousands of families in places like Kentucky, South Dakota and
 West Virginia manage to cobble together enough resources to make the 
move themselves; the share of Americans living in rural areas has slowly
 drifted down. In Clay County, the population has declined for the last 
decade. And the overall population in rural areas declined for the first
 time from 2010 to 2012, according to the Census Bureau.
Jeff
 Whitehead runs the Eastern Kentucky Concentrated Employment Program, 
which helps retrain laid-off coal miners and find them new jobs. 
“There’s just very limited opportunity for the people who were working 
in the region,” he said, adding that he helped 220 families move out of 
the area in recent years, despite many workers’ understandable 
resistance. “That’s a really hard pill to swallow. People are really 
connected to place here. For a lot of people, it’s the last thing 
they’re doing. They’re holding off until they have no other choice.”
But
 the number and proportion of people living in poverty in places like 
eastern Kentucky persists, despite all the trillions of dollars spent to
 improve the state of the poor in the United States and promote 
development. Ziliak thinks that efforts focused on human capital — 
meaning education initiatives, from prekindergarten all the way through 
college — might be the best use of any new money. But, of course, that 
also might mean more people moving away.
Annie Lowrey was, until recently, an economics reporter for The Times. Alan Flippen contributed reporting.

















