In southwest Virginia, reestablishing a rural hospital system requires rebuilding trust

When the sun rises over the Cumberland Mountains of southwest Virginia in mid-spring, it’s hard to imagine all’s not well in this world. Saturated in mountain laurel and flowering dogwood, this is picture-postcard central Appalachia. But for a good many people in these rural, remote counties, each day’s a challenge. All four of the Virginia counties that make up the state’s border with Kentucky and Tennessee are classified as distressed by the Appalachian Regional Commission, meaning they have substantially higher poverty or lower income levels than national averages. The local economy was once driven by coal and tobacco. Both have been in steady decline for more than a decade.