These 100 distressed counties lack college-educated citizens. Back in the 1960s Appalachia's problem was perceived to be isolation. And, while access remains a major problem for the most remote parts of the region, when Bill Clinton arrives he is going to find a region with deeply entrenched and highly complex problems. Appalachia's hard core won't be remedied by new roads and water pipes alone. The region's most critical shortage is its lack of democratic institutions.
Local governments are corrupt, from the county commissions to boards of education.
A vote buys a load of gravel and political protection. School districts are run as petty fiefdoms, doling out the only decent and secure jobs available. A hundred years of external ownership and concentrated power have left the region's citizens without the institutions they need to ensure their children safe and successful lives. Roads were built, but not honest governments. Yes, the region still needs water and sewer systems to abate the raw sewage being dumped into waterways.