# data[].attributes.body
If I never go to another snake handling church that's okay with me.

# data[].attributes.attachment_link.readable_text
A pale yellow church sits perched atop a hillside above a swift creek in Squire, West Virginia. Three wooden crosses are nailed to the side of the church with a purple sash draped over the middle. A sign up front welcomes all to the "House of the Lord Jesus."

The McDowell County church of Pentecostal faith welcomes all, without judgment, according to the church's pastor, Chris Wolford.

He said the House of the Lord Jesus is just like any other Christian-based church, with just a slight distinct difference - members take part in something called "taking up serpents," because the Bible tells them to do so.

The 25 to 30 members of the church worship like many other congregations in the area - with music, fellowship and food. But they also use snakes.

Wolford explains that the black and brown rattlesnake hissing in its wooden box on the altar is just a typical part of any normal Sunday service at the House of the Lord Jesus.

Serpent handling, now outlawed in every state except West Virginia, leaves many wary, but according to Wolford it's one thing he puts his full faith in.

The 45-year-old pastor was only 11 years old when he witnessed his father die from a snake bite during a church service. He says his dad had found something worth dying for.

"My father was an alcoholic, a mean man, but when he began serpent handling, I saw a change in his life," Wolford says. "I knew he got a hold of something unexplainable because he was a new creature in Christ.

"I realized that what he got a hold of, he loved enough to die for. He became a better man with this, and I saw that."

Seeing his father die didn't discourage Wolford or steer him away from serpent handling, but instead encouraged him even more to take part in the faith.

"I had seen him become a great man, and I knew I wanted to take part."

Wolford, a well-respected serpent handler in his small community, sat in a pew in his church, dressed in his Sunday best with khaki pants and a lavender button-up shirt. He and his brother, Mack Wolford, are the second generation of Wolfords to take part in serpent handling.

Mack Wolford died in 2012 from a snake bite he sustained during a service. Wolford says that just like his father, his brother laid down his life for the Lord.

"They had something in them that meant more to them than this world," he says. "The Bible says there's no greater love than man to lay down his life for a friend, and Jesus is the greatest friend anyone could ever have."

Although he spent most of his life in a serpent-handling church, it wasn't until Wolford went through a time he said was his lowest point before he actually began taking part in it himself.

"I used to be a drug addict. I was on pills, cocaine, shooting dope, I've done it all, but it wasn't until I gave my heart and soul to God that he set me free from all that," he explains. "I no longer desire the drugs, or desire the alcohol. He took that from me."

Wolford's church bases its belief upon the 16th chapter of the Gospel of Mark stating "and these signs shall follow them that believe; In my name shall they cast out devils; they shall speak with new tongues; they shall take up serpents; and if they drink any deadly thing, it shall not hurt them; they shall lay hands on the sick, and they shall recover."

The five signs are practiced within serpent-handling churches, including the sipping of strychnine, a poison, as a test of faith.

A jar with a clear substance is perched near the altar. A label with a black skull and cross bones and the words "poison" sticks to it.

Wolford takes a sip during service often, along with several others.

He says anyone who attends his church is given the option to not handle a serpent or sip on poison; nothing is forced. He says it all boils down to faith.

"It's the word of God; you can't debate it. It says so in scripture, but if you don't have the faith, don't take part," Wolford said. "I've got the Bible to back up my faith, but if you don't see that and you don't feel it, then don't do it. It's not the time.

"You won't be looked down upon. You do it when you're ready, when you have the faith. You'll know. God will move when he knows you're ready."

Wolford realizes many people on the outside of what he and his church members take part in may see it as "odd" or as "tempting God," but, he says, it's far from that.

For those who believe that about serpent-handling churches, Wolford says he has only one piece of advice - "study your scriptures."

"Unbelief is the only way God can be tempted," he explained. "The Bible says God cannot be tempted by evil, nor does he tempt any man.

"Someone is tempting him more by not believing in taking up serpents than I am by believing. The Bible says to do so. I believe it. I believe in his word."

Wolford pointed to scars on his hand, bites he's received since he began handling serpents.

He compares the pain from the bites to sucking through a straw and not being able to breathe.

The second bite, from a little over a year ago, was the closest to death he had ever been.

"Within 15 minutes I couldn't breathe, and lost all control of my bodily organs."

Like many serpent handlers, Wolford refuses to seek medical attention after he is bitten. He says he went home, but after 48 hours he just couldn't take the pain anymore.

"It was so much pain. It felt like someone took a hammer and was beating me in the heart with it. Finally, I told God I couldn't do it anymore and I was going to have to go to the hospital, but, in just a minute, the pain left me," Wolford says, snapping his fingers.

Seeking medical attention for a bite isn't frowned on after getting bitten, Wolford says, but is uncommon.

Once someone does get bit, he explains, the first thing they are asked is if they want to go to the hospital. If they refuse, they're prayed for, and the church will sit with the person while "the poison runs its course."

Getting bitten can mean many things, Wolford says, whether it was someone willing to lay their life down for God or they thought they were ready to handle a serpent, but really weren't.

"It's about waiting for God, being patient with God. If you don't have that faith inside of you, you shouldn't do it. If you're fearful, it's not the right time," he says.

Being scared of something such as a serpent is human nature, Wolford explains, but the joy you feel while handling a serpent the right way is overwhelming joy.

"When God moves on you, that fear goes away. When the spirit of God or the Holy Ghost begins to stir, he brings you so much joy."

During a near three-hour service, filled with music, foot stomping, dancing and prayer, the couple dozen people in the congregation rose to their feet to worship God. In the church's tradition, women wear skirts, wear no makeup and leave their hair uncut.

While Wolford gets into the worship, he begins to open the box, bringing the serpent to the forefront. The snake coils its body around Wolford's arm, and slides over his back. He shouts into the microphone excitedly.

"Woooweee, by the Grace of God!"

He wipes sweat from his forehead as he begins passing the snake to other men within the church. He grabs the jar of poison and takes a sip.

"The power of God!" he shouts again.

Wolford says any and all are welcome to the House of the Lord Jesus.

"We may look different, we may act different, and we may dress different; but we don't look down on anyone."

- Email: jnelson@register-herald.com; follow on Twitter @jnelsonRH

# data[].attributes.attachment_link.title
Preacher opens up about "taking up serpents," a display of faith (With VIDEO & PHOTO GALLERY)

# data[].attributes.attachment_link.description
A pale yellow church sits perched atop a hillside above a swift creek in Squire, West Virginia. Three wooden crosses are nailed to the side of the church with a purple sash draped over the middle. A sign up front welcomes all to the "House of the Lord Jesus."

# data[].attributes.body
The Grand Canyon of the South.
The Breaks Interstate Park

# data[].attributes.attachment_link.readable_text
A state park that borders Kentucky and Virginia wants to build the longest pedestrian swinging bridge in North America.

"It's designed to be 720 feet long, which is the longest swinging bridge in North America," said Austin Bradley, the superintendent for Kentucky's Breaks Interstate Park.

The proposed bridge would cross the Russell Fork river and connect the Virginia and Kentucky sides of the park to each other.

It will be made of steel and wood.

"We actually chose materials for our bridge that will blend into the natural environment," Bradley explained.

Since the park weaves between Kentucky and Virginia, Bradley said investors for the bridge hail from both states.

"On the Kentucky side, we've actually had the Kentucky Heritage Land Conservation Fund," Bradley pointed out. "On the Virginia side, we've had the Virginia Coalfield Economic Development Authority and the Thompson Charitable Foundation."

A Virginia Coalfield Economic Development Authority grant of up to $433,000 would help fund the bridge, with an additional $326,000 in funds from other sources earmarked for the bridge.

"So currently, we have about three-quarters of the funding that we need raised for the project," said Bradley. "It's really neat to see all these interstate funders come together."

The grant funds would also go toward other park maintenance and construction.

You will be able to see the bridge from the State Line Overlook, which is "one of the most popular overlooks in the park," according to the superintendent.

He told WHSV's sister station, WYMT, they want to create this bridge for multiple reasons.

"When it's built, it will connect not only the Virginia side of the park with the Kentucky side of the park, but it will also serve as a connector between the Appalachian Trail in Virginia, the Pine Mountain Trail in Kentucky and also this section of Rt. 80 that's adjacent to the bridge site as part of the TransAmerica Bike Trail," Bradley explained.

The Breaks is also a popular place for races.

Two race directors, Next Opportunity Events and 361 Adventures said one of the challenges that they have always faced is finding an easy path to get people from the Virginia side of the park to the Kentucky side.

"This bridge just opens up a lot of opportunities for them in terms of their races," Bradley pointed out.

The Breaks Interstate Park consists of around 5,000 acres and around 25 miles of trail.

Construction is set to start in late 2020 and end in 2021, with the opening scheduled for that spring.

# data[].attributes.attachment_link.title
Park seeks to build longest swinging bridge in North America at Kentucky-Virginia line

# data[].attributes.attachment_link.description
A state park that borders Kentucky and Virginia wants to build the longest pedestrian swinging bridge in North America. "It's designed to be 720 feet long, which is the longest swinging bridge in North America," said Austin Bradley, the superintendent for Kentucky's Breaks Interstate Park.

# data[].attributes.attachment_link.readable_text
The U.S. Army Corps of Engineers announced this week nearly $300 million in flood-control projects in Southwest Virginia that were necessitated by an April 1977 flood, which devastated areas of five states in the Appalachian region.

Widespread rains fell April 2-5, 1977, over the Appalachian region of Kentucky, Tennessee, Virginia and West Virginia. The heaviest rain fell on April 4 over the headwaters of many tributaries of the Ohio River, according to a report from the National Oceanic and Atmospheric Administration.

Record floods occurred along the Tug Fork and Levisa Fork, which are headwater tributaries of the Big Sandy River, the upper Cumberland River, Clinch and the Powell rivers. Severe flooding also occurred along the Holston River.

Twenty-two people were killed by the flooding, and property damages were estimated to be more than $400 million.

Dickenson and Buchanan counties in Southwest Virginia were especially devastated, leading the Army Corps of Engineers to begin funding a series of flood-control projects. This week, the agency announced school, home and business relocation and flood-proofing projects in the two counties.

Two lines of storms saturated the region with heavy rainfall, the NOAA report states. The first storm brought rainfalls typically less than 1 inch over the region. This was due to the rapid cold frontal passage in the late afternoon of April 2. The time of rain was restricted to the late evening of April 2 and the very early morning of April 3, the report states.

# data[].attributes.attachment_link.title
Pieces of the Past: Flooding in April 1977 killed 22 people in Appalachian region

# data[].attributes.attachment_link.description
The U.S. Army Corps of Engineers announced this week nearly $300 million in flood-control projects in Southwest Virginia that were necessitated by an April 1977 flood, which devastated areas of five states in the Appalachian region. Widespread rains fell April 2-5, 1977, over the Appalachian region of Kentucky, Tennessee, Virginia and West Virginia.

# data[].attributes.attachment_link.readable_text
HURLEY, Va. - Moving a Buchanan County high school, building a wall around another learning center and the voluntary floodproofing and acquisition of eligible structures are part of a nearly $236 million allocation to Buchanan County, Va. by the U.S. Army Corps of Engineers.

The U.S. Army Corps of Engineers announced Tuesday the allocation of $235.6 million to Buchanan County and $51.3 million to Dickenson County for flood risk protection.

"This announcement of funding from the U.S. Army Corps of Engineers (USACE) will lead to the completion of long-term floodproofing projects in Buchanan and Dickenson Counties," U.S. Rep. Morgan Griffith, R-Va. said after the announcement. "With their completion, communities in these jurisdictions will be better protected from the ravages of extreme weather."

U.S. Sen. Mark R. Warner and U.S. Sen. Tim Kaine, both D-Va. also announced the total of $286.9 million in federal funds from the USACE to complete long-standing projects in Buchanan and Dickenson counties.

The funding is made available through the Additional Supplemental Appropriations for Disaster Relief Act, a bipartisan bill supported by Warner and Kaine that was signed into law on June 6, 2019 to help communities construct flood and storm damage reduction projects, according to a statement the senators issued Tuesday.

"We're pleased to announce these federal funds to support the completion of critical flooding mitigation projects in Dickenson and Buchanan counties," Warner and Kaine said in a joint statement. "Once completed, these projects will better protect schools, local businesses, and homes from potential flood damage."

Buchanan County has seen major flood risk reduction projects in the past. One involved moving the entire town of Grundy, Va. out of a flood plain. The original joint agreement between the town, the county, the Virginia Department of Transportation and the U.S. Army Corps of Engineers involved the relocation of 75 families, non-profit organizations and businesses to a new redevelopment site across the Levisa River, according to past stories in the Bluefield Daily Telegraph.

The new plan drafted by the Huntington District of the USACE involves protecting areas that were impacted by an April 1977 Buchanan County flood which caused $198 million in damages, according to a project description provided by Griffith's office. The study area includes all the areas impacted during the 1977 flood on the Levisa Fork and upstream tributaries in Buchanan County, excluding the town of Grundy. About 730 structures are included in the area.

Under the U.S. Army Corps of Engineers plan, the project's primary components include a voluntary floodproofing and floodplain evacuation program. The Buchanan County Career, Technology & Higher Learning Center (BCCTHLC) qualifies for a ring wall to protect it from flooding, and Hurley High School qualifies for relocation.

Activities relating to the plan during fiscal year 2020 include completing the flood proofing agreement for the learning center and the relocation agreement for the high school, according to the USACE plan.
- Contact Greg Jordan at gjordan@bdtonline.com

# data[].attributes.attachment_link.title
Buchanan County to receive $236 million for floodproofing efforts

# data[].attributes.attachment_link.description
HURLEY, Va. - Moving a Buchanan County high school, building a wall around another learning center and the voluntary floodproofing and acquisition of eligible structures are part of a nearly $236 million allocation to Buchanan County, Va. by the U.S. Army Corps of Engineers. The U.S.

# data[].attributes.body
A town of 3,200 was flooded with nearly 21 million pain pills as addiction crisis worsened, lawmakers say

# data[].attributes.attachment_link.readable_text
Tug Valley Pharmacy was late to the gold rush, but swiftly made up for lost time.

To the watching investigators, the stone building with a peaked red roof looked more like a rural cabin than a fount for the millions of opioid pills spilling across Appalachia. The giveaway was the drive-thru window, and the cars lined up past the abandoned ghost shops in downtown Williamson, West Virginia.

The name of the pharmacy's owner, Samuel R Ballengee PharmD, was displayed on the window under a sales pitch: "It's all in the bag."

"Let's call this whole thing what it is. It's pretty much a cartel. A drug trafficking organisation," said Sgt Mike Smith of West Virginia state police, who spent years unravelling the web of doctors, pharmacists and drug companies that made rural Mingo county the opioid capital of America.

"Then right in the middle of this drug trafficking organisation, you have a little pharmacy that pops up and everybody's OK with it. I'm sitting here looking at this. It's hard to believe that was allowed."

It wasn't long before drug distribution companies, some of the largest firms in America among them, were delivering millions of opioid pills a year to Tug Valley. Millions more were shipped to another pharmacy, Hurley's Drug Store, four blocks away. All in a town of fewer than 3,000 people.

Twenty minutes' drive to the north, the Sav-Rite Pharmacy in the village of Kermit, population 280 and falling, was outstripping them both.

Drug distributors delivered more than 30m opioid pills just to those three pharmacies, in one of the poorest counties in America. Ballengee and the other drug store owners kept escalating the orders, and the distributors filled them without flinching. They shipped more narcotic painkillers to Mingo county per head of population than to any other place in the US.

Opioid makers such as Purdue Pharma and Johnson & Johnson shaped the medical culture that drove the surge in prescribing of narcotic painkillers that caused today's drug epidemic. Doctors wrote the prescriptions. But at the front end were thousands of pharmacies dispensing the pills, and among the pharmacists were profiteers.

No questions asked

In 2001, the West Virginia bureau of criminal investigation sent Smith to investigate a surge of opioids pills on the streets. At first he planned to approach it the way he investigated marijuana: by working along the chain from the user to the dealer to the producer with the threat of jail to prise information from suspects.

But Smith quickly discovered that users were happy to tell him where he could find doctors to write prescriptions and drug stores to fill them - no questions asked. They pointed him to Mingo county.

Smith went and watched. Each day, hundreds of people lined up outside an old animal feed store where a group of doctors were set up by a former pimp, just out of federal prison for running a gay prostitution ring in Washington DC, to churn out opioid prescriptions faster than West Virginia's major hospitals.

Before long, people in town were calling the Williamson Wellness Center a "pill mill".

The doctors were careful to insist their prescriptions were filled only at pharmacies that would take the money and not ask questions. But as word spread and people came from hundreds of miles around, so the drugstores struggled to meet demand.

Then, in a town where department stores shut years ago and traditional main street stores gave way to personal injury lawyers, a new drugstore popped up.

"Suddenly Tug Valley opens, out of the blue, in 2006. And there are big lines from the first day," said Smith.

Before long, it was outselling its rivals in town.

In the six years after Tug Valley opened, pharmaceutical distributors delivered nearly 11m of the most common type of opioid pill, hydrocodone. Month by month, the orders escalated. In 2009 alone, Ballengee ordered 3m hydrocodone pills.Hurley Drug was dispensing nearly as fast.

Across the river, Family Pharmacy was so busy that the owner, Larry Ray Barnett, had hundreds of bottles of pills lined up ready for assistants to grab as customers cycled through.

The Wellness Center was churning out so many opioid prescriptions that the fax machine couldn't keep up with transmitting them individually to the pharmacies. So the clinic didn't bother to send prescriptions at all and took to the illegal practice of writing lists of names and dosages on sheets of paper and faxing them to the pharmacies.

Investigators discovered the pharmacies lined up bottles pre-filled with set amounts of pills.

"The list comes in, you print out the name, slap a tag on the bottle. There you go," said Smith.

'Greed took over'

In the north of Mingo county, another pharmacist looked on enviously. James Wooley got so little business at his drugstore in the village of Kermit in the early 2000s that he also ran a used car business next door.

"He's a fine fella," said Charles Sparks, Kermit's mayor then and now. "You couldn't beat him as a person. But he just got into that other business, and it starts snowballing and greed took over. You know how it is: if I can make a million, I can make two."

Wooley decided to follow the Williamson model by setting up a doctor to churn out opioid prescriptions for him to fill. The pharmacist persuaded his assistant at the drugstore, Debra Justice, to set up a medical clinic just outside Kermit and they recruited a doctor more than an hour away at Marshall University's medical school, Dr John Tiano. All he had to do was lend his name to the prescriptions and one of the nurses at the clinic would fill it out.

The Justice Medical Complex opened in the spring of 2005, a 10-minute drive from Kermit. Prescriptions were sent directly to Wooley's pharmacy, the Sav-Rite. The circle was complete.

Within a few months, Wooley was filling an opioid prescription a minute in a town of fewer than 400 people. The pharmacy bought more of the opioid than any drugstore in West Virginia or neighbouring states that year and ranked 22nd in the nation among retail pharmacies for hydrocodone purchases. Gross sales surged above $6.5m.

Sparks, the mayor, watched the influx.

"Oh, we were aware. We knew what was going on. The citizens would come and say, 'Why don't you do something about that up there?' The average person doesn't know or doesn't stop and think that you can't just go in. You have to do an investigation before you can stop something like that. People said nothing's being done."

Missed opportunities

The two decades of the opioid epidemic is a story of missed opportunities, large and small.

If the warnings sounded by pain specialists and doctors in the first few years had been heeded, the crisis might have been averted or at least greatly diminished. If federal regulators had intervened to limit prescribing of high-strength opioids to those who really needed them, there would have been far fewer pills on the streets.

West Virginia's medical regulators missed opportunities too. In 2007, someone anonymously tipped off the West Virginia medical board that Tiano was prescribing illegally. The board's punishment was to require him to write a "book report" on a medical textbook called Responsible Opioid Prescribing: A Physician's Guide.

Marshall University forced Tiano to stop moonlighting at the clinic. On his way out the door, having made more than $250,000 from opioid prescribing in just two years, the doctor recruited his successor, Dr Augusto Abad, who lived 90 minutes away in the state capital, Charleston, and rarely saw patients. But plenty of prescriptions were written in his name.

By then, Smith was watching. He worked with an FBI agent, Joe Ciccarelli, with a long history of drug investigations. Ciccarelli had come from pursuing Colombian cartels in Florida, but he already knew West Virginia well from working the drug beat as a police officer in the early 1980s.

"These junkies would forge prescriptions, and back in the pre-computer days I can remember standing in pharmacies going through prescriptions going, 'that's a junkie, that's a junkie, these are false scripts'," said Ciccarelli, who has since died, in 2017.

An informant tipped them off that Debra Justice and Wooley had hatched a get rich(er) quick scheme to open a pain clinic that would refer all of its prescriptions for controlled substances to Sav-Rite Kermit, and that they were "handing out drugs like candy".

Mary Ann Withrow, a federal agent, said investigators recorded that the Sav-Rite and the clinic were "excessively busy" for such a small town.

One undercover agent noted that the cash drawer at the Sav-Rite was so full the assistant couldn't close it. Something similar was going on at the Tug Valley Pharmacy and Hurley's in Williamson.

"It looked like a carnival," said Smith. "There's no way people down there didn't know what was going on. There was a lot of money being made."

Federal charges

Years later, all of the pharmacists claim to have not seen any of this.

Ballengee was arrested in July, days after an Ohio court released Drug Enforcement Administration documents showing that pharmaceutical distributors delivered millions of opioid pills to his tiny pharmacy.

Federal prosecutors charged him with making millions of dollars from illegally supplying opioids alongside Anthony Rattini, the former president of Ballengee's major suppliers, Miami-Luken, and others. Rattini is accused of distributing narcotic painkillers illegally to more than 200 pharmacies across West Virginia, Ohio, Indiana and Tennessee.

Ballengee testified in earlier civil depositions that he was filling between 150 and 200 opioid prescriptions a day from the Wellness clinic alone, but claimed to see no reason for suspicion. He denied knowing that the clinic was widely spoken about in town as a "pill mill". He also said he was unaware that Williamson was nicknamed "Pilliamson", or that a doctor who was one of the main prescribers was known as "Pill Billy".

Barnett, who owned Family Pharmacy, also professed not to know the reputation of the Wellness Center or that it had a list of acceptable pharmacies for patients to fill opioid prescriptions and that his was on it. Like Ballengee, he claimed not to know about the reputation of the prescribing doctors, including one who was described in a local newspaper as "a danger to the community because he prescribed thousands of addictive pills without legitimate purpose". He saw no red flags even as the prescriptions poured in by fax and phone.

Under oath, Wooley said he didn't remember ever seeing articles in trade magazines warning about escalating opioid addiction, or patients going from one doctor to another in search of multiple prescriptions.

Smith went to federal prosecutors with the evidence about the illegal lists of prescriptions and pressed them to file charges. The policeman said it fell under the definition of wire fraud.

"I tried to use the wire fraud to get everybody, the pharmacies and the doctors. They didn't go for that," he said.

So he went to the West Virginia board of pharmacy.

"They said I was right in what I was alleging. However, what they did is they talked to the pharmacists and told them they couldn't do that any more," he said. "The whole thing was a game, a scam. Everyone was going along with it."

Eventually, the FBI and state police moved in on the Sav-Rite in Kermit in 2009, arresting Wooley.

"We're standing out there with a couple of uniformed troopers and cars just keep going up," said Ciccarelli. "Where are you from? I came from Point Pleasant. OK, let's see. You passed about three hospitals, probably 50 pharmacies, and you're driving 100 miles from Point Pleasant to Kermit to pick up a prescription? It's things like that you can put in front of a jury and they're going to go, that ain't right. You stack those things up and a jury's finally going to say, I don't believe this."

Wooley pleaded guilty to illegally selling prescription medication and conspiracy, and went to prison for six months in 2012. The doctors at the clinic he set up were each jailed for a year. Tiano lost his medical licence. On his release, Abad was deported to his home country, the Philippines, where he continues to practise.

"It boggles my mind," said Sparks, the mayor. "I was blown away. I thought, 'My God, almost 9m pills in two years went out of here, and Wooley said that he made $500,000 a month in a little town of 400 people.'"

The following year, the FBI and state police raided the Williamson clinic, arrested doctors and cut off the opioid pipeline. The numbers of prescriptions fell sharply.

In 2016, a major drug distributor, McKesson abruptly ended its contract with Tug Valley Pharmacy when West Virginia's attorney general, Patrick Morrisey, filed a lawsuit against the company accusing it of recklessly distribution millions of pills across the state. Earlier this year, McKesson paid the state $37m to settle the suit. In 2017, the West Virginia board of pharmacy dismissed its director for failing to properly regulate the flood of opioids to the state's pharmacies and investigate suspicious deliveries.

Prosecutors prepared charges against Barnett, but he died before he could be brought to trial.

Up until his arrest, Ballengee continued to insist that he was doing no more than filling prescriptions written by doctors. He is now awaiting trial.
Chris McGreal is the author of American Overdose, The Opioid Tragedy in Three Acts Topics

# data[].attributes.attachment_link.title
Why were millions of opioid pills sent to a West Virginia town of 3,000?

# data[].attributes.attachment_link.description
Tug Valley Pharmacy was late to the gold rush, but swiftly made up for lost time. To the watching investigators, the stone building with a peaked red roof looked more like a rural cabin than a fount for the millions of opioid pills spilling across Appalachia.

# data[].attributes.body
People sometimes find it odd that this was my high school and I married a POC.

# data[].attributes.attachment_link.readable_text
HURLEY, Va. - Chris Spencer is the only African-American student at Hurley High School, where the front doors he walks through each morning are painted with the Confederate battle flag, the first of many he'll see on any given school day.

The helmets of his Hurley Rebels football team sport a stylized logo of the flag, flying from a saber. Equipment in the weight room is stamped with the image too. Crossed battle flags are on the wall in the school's main office. Rebel Man, with a rebel flag, adorns center court in the gym.

But Spencer needn't wait until he arrives at school to see such images. He carries one with him wherever he goes. The senior running back has a battle flag tattoo on the underside of his right forearm, where he cradles the ball on each carry.

"It doesn't mean racism to me," Spencer tells USA TODAY Sports. "I just look at it as a flag. It's our mascot. It just means our school."

That's the party line in Hurley, a tiny coalmining community tucked into the southwest corner of Virginia, south of Kentucky and west of West Virginia, where longtime citizens say they just want to be left alone to rally around a symbol that's been with them for as long as they can remember.

"It means heritage, not hate," Hurley High principal Pam Tester says. "You won't find a single person in Hurley who thinks different."

And that includes Spencer, who wears his heart on his sleeve and his tattoo under it. In a community that's overwhelmingly white, the artwork on his arm is often offered as Exhibit A for the defense.

"We got one black kid, and look at his arm," says Steve Blankenship, whose grandson plays for the Rebels and whose cousin Tommy is running for school board with flag-emblazoned lawn signs.

Much of the rest of the nation sees the battle flag as an unfurled symbol of slavery and segregation. "That's not what it means here," Tester says. "Never. Virginia is for lovers."

Renewed scrutiny of the rebel flag in public spaces emerged this summer in the wake of a massacre of nine churchgoers in South Carolina. The alleged white supremacist gunman posed with a Confederate battle flag in a photo taken before the shooting. Since, South Carolina removed the flag from its statehouse grounds and Alabama did the same. Mississippi retains the battle flag that's incorporated in its state flag, though football coaches at Ole Miss and Mississippi State are among those who say it should go.

Rebels is the nickname at roughly 200 high schools across the USA and these days several are reviewing the name and attendant imagery. Southside High in Fort Smith, Ark., is phasing out its Rebels name and ending Dixie as its fight song. Vestavia Hills High in Alabama is rebranding its Rebels, keeping the name but eliminating some of the symbols.

No such introspection is apparent in Hurley, an unincorporated community in Buchanan County, one of Virginia's poorest. The county was founded in 1858, just before the Civil War, and according to the 2010 census had a population of a little more than 24,000, roughly 97% white.

Hurley's population is estimated a bit above 3,000. On game nights, it can feel as if all of them are at The Cliff, a one-of-a-kind stadium where Smiley Ratliff Field is blasted out of rock. Behind one end zone, and behind most of one sideline, is sheer stone. You can get a stiff neck peering up to the tree-topped summit.

Tester says dynamite cleared the way for this field of dreams sometime in the early 1980s. "We're miners here," she says. "We know how to do that."

It's the sort of can-do spirit that animates mountain pride hereabouts: When you can't find 100 yards of flat earth, you make it. But coal is disappearing as a way of life and that means less work in Hurley. Darwin Bailey is out of work just now. His friend, Roger Hurley, finds common ground between unemployment and anti-flag deployment.

"The liberals and the tree huggers want to shut down the mines," he says. "And next thing they'll want to shut down our flag too."
GALLERY: AROUND HURLEY HIGH SMILEY RATLIFF'S LEGACY
Smiley Ratliff Field is named for the founding father of Hurley High football - and of the school's rebellious nickname.

His name was Arthur M. Ratliff Jr., though everyone called him Smiley. He coached the first Rebels squad in 1951 that played just four games with borrowed equipment, according to Sam Varney, 80, who played on the original teams. The school's first full season in 1952 brought its first championship with a gambling single-wing attack, as Varney recalls.

"We went from nothing to champions," he says. "Smiley often said his assistant coaches were Genghis Khan, Napoleon and Robert E. Lee."

Ratliff had more winning seasons in 1953 and 1954 and then left coaching to make his fortune in coal before branching into banking and real estate holdings. The Washington Post ran a profile of him in 1982 that said he parlayed a $1,500 bank loan into an estimated $100 million empire by mining coal with the same hellfire abandon he'd used to outflank opposing football teams.

The story describes a man who hated Franklin Roosevelt for eroding initiative, Earl Warren for destroying justice, Elvis for ruining music - and government for over---regulation. "I'm a general on the battlefield of life," Ratliff told the Post. "Why, hell, God created me to win."

Ratliff's ancestors fought for the South in the Civil War and "he told me he was born too late" to fight in it himself, Varney says, though Ratliff did fight in World War II and Korea, earning an array of medals for his service, including two Purple Hearts and a bronze star for valor.

Ratliff died at 83 in 2007. His legacy is The Ratcliffe Foundation, harkening to an earlier spelling of the family name. The foundation has net assets of more than $24 million, according to its most recently available IRS 990 form. Varney is one of its officers. Among its beneficiaries some years is Hurley High, where a field house named for Ratliff is filled with the latest weightlifting equipment - and more than a dozen images of the rebel flag.

Ratliff thought that flag "denoted courage, valor and states' rights," Varney says. "It was not adopted really for anything connected with slavery or hatred or anything that those who are being vocal about it say."

What would Smiley think about statehouses and high schools retiring the battle flag? "You can't print that," says Varney, who's pleased local sentiment is to keep it flying high in Hurley.

"To change it because someone else doesn't like it," he says, "goes against the grain of mountain independence."
'WE DON'T MEAN ANY DISRESPECT'
Greg Tester, the principal's nephew, is Hurley High's football coach. He wants outsiders to know what a good place Hurley is, how everyone knows everyone else and takes care of one another - and how the battle flag is part of all of that as a symbol of spirit, tradition and pride.

"I respect other points of view," he says. "We don't mean any disrespect at all."

Tester's assistant coaches are not Napoleon, Kahn and Lee but Brandon Davis, Dustin Waynick and Travis Quinley.

"I'm 33 years old and the (front) doors have always had the flag," Davis says. "Once, when we got new (doors), people started calling to see how soon the flag would be painted back."

Hurley has an enrollment of 180 boys and girls in grades 9-12. That makes the Class A school one of the state's smallest to field a football team. Tester says he has a roster of 40 this season, including ninth graders, and that every team the Rebels play is bigger - notably Class AA Grundy, bitter rival down the road.

Grundy players stomped and spit on a rebel flag when they won a tight game in 2013, tight end/linebacker Josh Mullins says, turning the tone of this mountain feud into something even fiercer. The Rebels took revenge in 2014 with a 66-8 stomping, Hurley's first win in the series since 1991. Cue the Hatfields: Rachel McCoy scored the last points on a two-point conversion. She graduated a local legend.

"We're like a small-town Texas team you read about," Quinley says. "We're just tucked away in the Appalachian Mountains."

Blankenship, watching a crisp practice on a steamy afternoon, explains how much the Rebels, and the rebel flag, mean to this tight-knit town. He points to a spot near the precipice behind the end zone, where the battle flag was long ago painted into rock, the faded remains still visible if you know where to look, leaving stunned viewers to ponder how on earth the painter got up there.

"Got to be 150 feet, easy," Blankenship says. "That's what's called loving your flag, ain't it?"

Those who oppose it say the rebel flag stands for the fight for slavery in the Civil War - and the fight against civil rights a century later. Blankenship brands that as political correctness and agrees with Donald Trump, who said in a different context in this month's Republican debate that political correctness is a big problem in the country.

"Everything he says, I like," Blankenship says. "It's like he's reading my mind."
WHAT THEY CHOOSE IT TO MEAN
It is Friday night in mid-August, "Meet the Rebels" night at The Cliff. Hundreds pay $3 to be there for an evening of bows and smiles, sort of like a football game if it ended after the introductions. Only here it isn't just the players introduced - it's players plus cheerleaders in iterations from varsity to pee-wee. Fans munch on chili dogs and popcorn. Parents and grandparents watch the festivities under rebel flags flapping in the breeze atop the bleachers.

The players gather in the locker room before their introductions and Pastor Eugene Whited of Blackey Baptist Church offers a sermon near the mount. He tells the team the game of football is like the game of life and they should remember Philippians 4:13, how they can do all things through Christ, who strengthens them.

Minutes later the pastor offers a prayer over the stadium sound system. Then, show time: The Rebels charge onto the field, Mullins carrying the battle flag as if into battle, and the crowd roars.

The vibe is small-town sweetness, but as the night winds down Rebels fans Darwin Bailey and Roger Hurley introduce themselves to a reporter to ask some pointed questions. They wonder why USA TODAY Sports is here. They worry that any publicity will be negative publicity, because outsiders can't truly understand their love of town, team and flag.

"It has nothing to do with hatred or anything else they want to say," Bailey says. "We're one big family here. You can see that tonight."

Roger Hurley says a national story can only lead to no good. "When this hits USA TODAY, we're ruined," he says, predicting protesters from elsewhere will arrive before this season is out. "Why punish the kids?"

Buchanan County's motto is "Nature's Wonderland." Hurley offers echoes of Alice's.

Humpty Dumpty tells Alice in Through the Looking-Glass, and What Alice Found There: "When I use a word, it means just what I choose it to mean - neither more nor less."

Substitute symbol for word and you have Hurley and its rebel flag. Here, residents believe that flag means what they choose it to mean. They don't much care whatever it might mean to a wider world they'd rather not hear from. They just want to watch their Rebels score touchdowns at The Cliff, where that flag painted high on rock face fades ever so slowly into history.

# data[].attributes.attachment_link.title
At Hurley High, Confederate battle flag is everywhere and means everything

# data[].attributes.attachment_link.description
As schools reconsider use of Confederate imagery, a rural town rallies around the symbol

# data[].attributes.attachment_link.readable_text
by: News Channel 11 Staff

Posted: / Updated:

(Photo: BCSO)

GRUNDY, Va. (WJHL) - Authorities have arrested eight people on drug-related indictments in Buchanan County.

The Buchanan County Sheriff's Office says the arrests were made on Tuesday.

The sheriff's office worked with the 19th Judicial Drug Task Force and Virginia State Police. VSP's tactical team was used in the operation.

The sheriff's office says crystal methamphetamine and marijuana were seized.

The following arrests were made:

Matthew Eugene Stevens, 32 of Pilgrams Knob, VA

4 counts of Distribution of Schedule I/II controlled substance

3 counts of Common Nuisance

Angie Renee Tester, 53 of Hurley, VA

5 counts of Distribution of Schedule I/II controlled substance

2 counts of Distribution of Schedule III controlled substance

1 count of Conspire to Distribute Schedule I/II controlled substance

4 counts of Common Nuisance

Buddy Nicholas Hurley, 43 of Big Rock, VA

1 count of Distribution of Schedule I/II controlled substance

Matthew Allen Yates, 30 of Grundy, VA

1 count of Distribution of Schedule III controlled substance

1 count of Common Nuisance

Betty Sue Fuller, 65 of Vansant, VA

2 counts of Distribution of Schedule III controlled substance

1 count of Common Nuisance

David Hunt, 52 of Hurley, VA

1 count of Distribution of Schedule I/II controlled substance

1 count of Conspire to Distribute Schedule I/II controlled substance

Richard Mark Griffey, 45 of Hurley, VA

1 count of Distribution of Schedule I/II controlled substance

1 count of Common Nuisance

Tammy Mae Shortridge, 53 of Grundy, VA

2 counts of Distribution of Schedule I/II controlled substance

1 count of Common Nuisance

The sheriff's office says additional suspects are being sought.

# data[].attributes.attachment_link.title
Authorities arrest eight on drug charges in Buchanan County

# data[].attributes.attachment_link.description
GRUNDY, Va. (WJHL) - Authorities have arrested eight people on drug-related indictments in Buchanan County. The Buchanan County Sheriff's Office says the arrests were made on Tuesday. The sheriff's office worked with the 19th Judicial Drug Task Force and Virginia State Police. VSP's tactical team was used in the operation.

# data[].attributes.attachment_link.readable_text
BUCHANAN CO., Va. (WVVA) - On June 19th, 2020, the Buchanan County Sheriff's Office executed a search warrant at a residence located in the Osborne Mountain area of Buchanan County, VA.

The two month investigation was conducted with assistance from the Dickenson County Sheriff's Office, Virginia State Police, the 29th Judicial Drug Task Force and Grundy Police Department.

The Virginia State Police Tactical Team was utilized in the execution of the search warrant.

As a result of the investigation and search, fourteen (14) firearms, illegal drugs, including a large amount of crystal methamphetamine, heroin, Schedule III and Schedule IV narcotics and approximately $14,000 were confiscated.

Three people have been arrested. Their information and charges are listed below.

Justin Warren Meadows, 35 years old, of Raven, VA is charged with two (2) counts of VA Code § 18.2-248, possession of a Schedule I or II with intent to distribute (felony), two (2) counts of VA Code§ 18.2-308.4 , possessing a controlled substance classified as a Schedule I or II simultaneously possess a firearm (felony) and one (1) count of VA Code § 18.2-308.2, possess a firearm after having been convicted a violent felony. Meadows is being held at the Southwest Virginia Regional Jail Authority Haysi Facility without bail and is scheduled to have an arraignment in the Buchanan County General District Court on Tuesday, June 23, 2020.

Tiffany Dawn Hockman, 25 years old, of Raven, VA is charged with two (2) counts of VA Code § 18.2-248, possession of a Schedule I or II with intent to distribute (felony) and two (2) counts of VA Code§ 18.2-308.4 , possessing a controlled substance classified as a Schedule I or II simultaneously possess a firearm (felony). Hockman is being held at the Southwest Virginia Regional Jail Authority Haysi Facility without bail and is scheduled to have an arraignment in the Buchanan County General District Court on Tuesday, June 23, 2020.

Clyde Perry Osborne, 45, of Raven, VA VA is charged with two (2) counts of VA Code § 18.2-248, possession of a Schedule I or II with intent to distribute (felony) and two (2) counts of VA Code§ 18.2-308.4 , possessing a controlled substance classified as a Schedule I or II simultaneously possess a firearm (felony). Osborne is being held at the Southwest Virginia Regional Jail Authority Haysi Facility on a $3,000.00 secure bond and is scheduled to have an arraignment in the Buchanan County General District Court on Tuesday, June 23, 2020.

Sheriff McClanahan would like to thank all law enforcement officers who assisted in the investigation, including Lt. Mitchell and Deputy Hagy. Sheriff McClanahan says, "This is a prime example in how cooperation between agencies and good police work comes together to fight the flow of this poison hitting our communities. I expect more investigations like this one in the future and look forward to working with neighboring law enforcement agencies in accomplishing that."

Stay with WVVA for updates.

You can watch all of our newscasts live on our App and website here: https://wvva.com/watch-wvva-live/

# data[].attributes.attachment_link.title
Drugs, thousands in cash, and 14 firearms confiscated during search warrant

# data[].attributes.attachment_link.description
BUCHANAN CO., Va. (WVVA) - On June 19th, 2020, the Buchanan County Sheriff's Office executed a search warrant at a residence located in the Osborne Mountain area of Buchanan County, VA. The two month investigation was conducted with assistance from the Dickenson County Sheriff's Office, Virginia State Police, the 29th Judicial Drug Task Force and Grundy Police Department.

# data[].attributes.attachment_link.description
In 1923, the number of people earning a living mining coal in the United States peaked at 862,536. Now, that number is around 52,000, and many people and companies who relied on coal for income have fallen on hard times. That's one reason the 2019 expansions of Paul's Fan Co., which has been tied to...

# data[].attributes.attachment_link.readable_text
Some problems simply have no solutions. Math is full of them and they all have exotic names: Crouzeix Conjecture. The Pompeiu Problem.

The New York Times economics writer, Eduardo Porter, recently travelled to Southwest Virginia to visit Grundy. He looked at all the ways the town and surrounding Buchanan County have tried build a post-coal economy. A law school. A pharmacy school. Tourism for all-terrain-vehicle trails or a re-introduced elk population. The question the story posed: "Can a coal town reinvent itself?"

What if the answer is the same as with all those math problems? What if the answer to the Coal Town Problem is "no"?

For all of the millions spent on Grundy - $170 million alone to relocate downtown as part of a flood-control program - Porter writes that the town's basic problems remain. "We are a one-industry town, and that's coal," says Jay Rife, the head of the county's Industrial Development Authority. And coal continues its inexorable decline, as the world shifts to forms of energy other than coal. As coal jobs disappear, so do people. The county's population is down by 10.5% since 2010 -a faster rate of decline than any other county in the state. The middle and elementary school population has shrunk even faster - by a fifth - in the past decade. The remaining population is old and getting older. About the only thing up in the county are Social Security payments and Medicare payments. Porter quotes one county resident who laments: "This county will never prosper again."

Is he right? What if a coal town can't reinvent itself? The story quotes a local contractor: "There has been a ton of money spent in Buchanan County through grants. Not one penny has provided a replacement job for coal workers."

This is a problem for more than just Grundy or other coal towns; it's a problem for other small communities across the country that have seen their traditional employers wither and die - and not be replaced. The vaunted "new economy" is happening somewhere other than here. A new report by the Brookings Institution finds that just five metro areas in the country accounted for 90% of the growth in "innovation sector" jobs.

The New York Times story doesn't offer solutions, it simply documents the problem and poses a question without an answer.

What we notice more are the 326 comments on the online version of the article - comments that came from all around the world. Online comment sections are usually full of answers, wrong or otherwise. This one isn't. There are a few people who suggest that Grundy transition from coal to renewable energy - build solar panels or wind turbines on all those former coal mines. The idea of turning coalfields into "brightfields" is one we've heard before - we've even written favorably about it ourselves. Here's the problem, though. First, who will actually do this? We live in a free market economy. Local governments aren't building solar farms or wind farms. So who will? That requires private investment, which is nowhere in sight. Other commenters pointed out a second problem: Such brightfields might be good for the environment, but they don't necessarily create a lot of employment - certainly not on a scale to replace coal. The solar panels and wind turbines wouldn't be made in Grundy. Some 60% of the world's solar panels are made in China. Likewise, only one of the top 10 turbine manufacturers is located in the U.S.

Instead, most of those commenting offered condolences - but no solutions. Instead, many people pointed out an uncomfortable truth: Lots of towns die. One reader from Ohio wrote: "I have sympathy for the people of Grundy who are watching their way of life vanish. However, the sad reality is that (1) coal is going away for both economic and environmental reasons; (2) the geography of that area does not lend itself to uses other than coal . . . History, and even our relatively young country, are littered with ghost towns. The younger generations need to move on. Even though I live in a prosperous area, all of my adult children have followed career opportunities wherever they are, and as a result we are scattered around the U.S. Like it or not, they also must start thinking that way. As a taxpayer, I am more than happy to support job training and education, but I shouldn't be expected to subsidize a dying coal town just because they wish the past would return."

There are hundreds of comments along those lines. Here's a pithier one from New York: "These people need to get moving. It's not like they have to move to another country and learn a new language, like many of our parents and grandparents did. When the lake dries up, even the animals know it's time to move on." Here's an even pithier one from North Carolina: "The only infrastructure improvement that could help residents of Buchanan County would be to improve roads so its remaining residents can leave faster."

Some of these answers are harsh, but they're no different from ones we've heard prominent people in the region sometimes whisper to us: Maybe parts of Appalachia can't be saved so maybe we shouldn't even try. In effect, they argue for a form of "benign neglect" to let the region depopulate over time. We notice, of course, politicians don't propose that - but the equally harsh reality is we don't see a lot of politicians proposing much of anything. Local politicians do, of course, but they don't control the most important levers of power. At the national level, neither Democrats nor Republicans have anything really substantive to say about how to break up this unprecedented concentration of economic growth in a handful of communities and re-direct some of it to rural America. They simply don't talk about it - not Donald Trump on the right, not Bernie Sanders and Elizabeth Warren on the left, not any of them.

Instead, reader after reader commented on the The New York Times story that what's happening in Appalachian has happened other places before. Harry in Michigan writes: "It seems most coal towns are just welfare queens waiting for the feds to bail them out, again and again. Copper used to be mined in the [Upper Peninsula] in Michigan. Did the government spend hundreds of millions trying to keep people from leaving?"

So what's the takeaway here? Is there no economic solution for much of rural America? That's one possible answer. Another is: If there is a solution, Grundy and other places in rural America will have to find it on their own, because it's clear nobody else is going to help.

Get opinion pieces, letters and editorials sent directly to your inbox weekly!

# data[].attributes.attachment_link.description
Some problems simply have no solutions. Math is full of them and they all have exotic names: Crouzeix Conjecture. The Pompeiu Problem. The New York Times economics writer, Eduardo Porter, recently travelled to Southwest Virginia to visit Grundy. He looked at all the ways the town and surrounding Buchanan County have tried build a post-coal economy.

# data[].attributes.attachment_link.readable_text
The SunCoke Energy plant near Grundy, Va., the seat of a county where mining once provided 5,000 jobs. Credit... Julia Rendleman for The New York Times

A coal town in southwestern Virginia has been trying for years. Hope is running thin.

The SunCoke Energy plant near Grundy, Va., the seat of a county where mining once provided 5,000 jobs. Credit... Julia Rendleman for The New York Times

GRUNDY, Va. - Jay Rife surveys the landscape - hundreds of flat, grassy acres reclaimed from a spent mountaintop mine once operated by the Paramont Coal Company. A few handsome homes stand on one end of the project. An 80,000-square-foot shell, to house some future manufacturing operation, is being built on another. For the intrepid, there are trails for all-terrain vehicles. There's an R.V. park. The whole site has been wired for broadband. Elk have been imported from Kentucky for tourists to look at.

Buchanan County, where Grundy sits, has spent $35 million to $40 million on the development, called Southern Gap, some seven miles from town along U.S. 460. Mr. Rife, the head of the county's Industrial Development Authority, says the project "is going to be the salvation of Buchanan County."

Few places have had as many shots at deliverance. None, so far, have succeeded in stemming Grundy's inexorable decline.

This corner of southwestern Virginia has long sought alternatives to coal as a source of sustenance. The Appalachian School of Law, which opened in the 1990s in the shell of Grundy Junior High School, was heralded as a new economic engine, lubricated - of course - with taxpayer funds. So was the Appalachian College of Pharmacy, founded in 2003 some 20 minutes down the road in Oakwood. County officials considered a dental school, but figured it was too expensive. They still get grumpy about the optometry school, on which they spent $250,000 in feasibility studies only for it to open across the state line in Pikeville, Ky. Then there is downtown Grundy itself, much of which was moved up the hill to avoid periodic floodwaters from the Levisa Fork, a tributary of the Big Sandy River.

Virginia estimates that the relocation and flood-proofing projects, started almost 20 years ago, cost $170 million in federal and state funds, more than $170,000 for every woman, man and child living in town today. The Army Corps of Engineers shaved off the flank of a mountain across the river to create an elevated platform on which the new commercial district would sit. Virginia's Department of Transportation bulldozed much of the old downtown and routed U.S. 460 through it, built on top of a levee protecting what was left of Grundy's old center. Finally, in 2011, Walmart opened a superstore to anchor the new site, perched somewhat oddly above a two-story, publicly funded parking lot.

Today, a Subway and a Taco Bell are there, too, alongside a restaurant called El Sombrero, run by the only Mexican immigrants in town. There are a Shoe Sensation, a Verizon outlet and a Double Kwik gas station. Still, the effort does not quite amount to a reinvention. The economic engine is still the one that carried this corner of Appalachia through the 20th century. "We are a one-industry community, and that's coal," Mr. Rife said. A few steps from Walmart, an office of Welmore Energy, a coal-producing subsidiary of the Ukrainian steel conglomerate Metinvest, serves as a reminder of that dominance.

And that, today, is a problem. At the peak of coal's fortunes in the 1970s, more than 35,000 people lived in Buchanan. Over 5,000 worked in the mines. Mr. Rife remembers downtown sidewalks in Grundy, the county seat, packed with thousands of people on weekend shopping expeditions. Karen Brown, the principal of Grundy High School, recalls Porsches and Mercedes-Benzes parked in the high school lot when she went to school there.

Image

Karen Brown, principal of Grundy High School, said luxury cars were parked there when she was a student at the school. Credit... Matt Eich for The New York Times

Coal is still the most prominent business, employing one in six workers in the county and accounting for one-third of its total wages. But it can no longer support such living standards. The income of Buchanan County's residents has fallen to about two-thirds of the national average. And about 40 percent of that comes from federal transfers like Social Security.

The county population has declined to under 22,000, of whom almost 3,500 people receive disability benefits. Over a quarter live in poverty. And it is getting old. The only age group that has grown in the last two decades is the population over 55. Ms. Brown's high school, which housed about 1,000 students when she was there, these days educates just a bit over 400. The county's elementary and middle school population has shrunk by a fifth over the last 10 years, to under 2,000 students.

Grundy is hardly unique. It is one of many victims of globalization, technology and other economic dislocations that have wreaked havoc with small-town America. For years, most economists argued that rather than spend millions in pursuit of a new economic engine for such places, it would make more sense to help residents seek opportunities elsewhere.

But the proliferation of towns like Grundy across what used to be the nation's industrial heartland - stymied by joblessness, awash in opioids and frustration - has prompted a new sense of alarm. At a recent conference organized by the Federal Reserve Bank of Boston, Lawrence H. Summers, once a top economic adviser to President Barack Obama, put it this way: "There is probably no issue more important for the political economy of the next 15 years, not just in the United States but around the world, than what happens in the areas that feel rightly that they are falling behind and increasingly left apart."

Since the last industry peak, in 2012, the coal mines of Buchanan County have shed 1,000 jobs - roughly half. And they are not paying quite as well as they once did. Mikey Elswick estimates that 90 percent of his family has worked in the coal industry, including his father, his uncle and his brother-in-law. Still, he got out four years ago after Cambrian Coal bought the mine where he worked and said it would cut wages to around $20 an hour from $22.50. Luckily for him, the local exterminator was retiring and let him take over the business, including his roster of clients.

"There are not many jobs around here," Mr. Elswick said. "Just teachers, state troopers and coal." Cambrian Coal filed for bankruptcy in July.

Migration, as economists would have predicted, has become an increasingly compelling option: Those lucky enough to find work somewhere else leave. They include Ms. Brown's two daughters - Peyton, 23, and Bailee, 25 - who last summer followed their husbands from the coal industry to more stable jobs at the Toyota plant in Georgetown, Ky.

"There are more restaurants, more shops, more like a downtown area, more traffic, more places to live," Peyton said. While it will be tough to start a family so far from her parents, a three-and-a-half-hour drive away, she added, "it would not be wise for us to go back home." The economics just don't work.

Luckily, she already has a job, as a bank teller, and a community to rely on. "Friends that me and my husband went to high school with are down here already," she said.

Brian Ward owns a small company he started, to provide crews and equipment to coal minesin the area, but has been forced into residential construction - remodeling, mostly - as coal has waned. Migration is not new, he said.

"We lost one generation of workers to Detroit, another to the Carolinas," he said. These days, workers will go anywhere. "I don't know where we are losing them to now," Mr. Ward added.

Buchanan County is in some ways better off than other coal-mining regions. To be sure, its coal production has shriveled, virtually pushed out of the power market by the cheaper coal coming from the gargantuan open-top mines in the West since the 1980s. Automation has also taken out thousands of jobs.

But the county is bountiful in what's known as metallurgical coal, used in steel making. Much of it is exported. This insulates local mines from the transition that power plants are making to natural gas. Indeed, coal jobs in the county experienced a bump starting in 2016, driven by exports to Europe and Asia. And while that has passed, as growth prospects overseas have dimmed, steel making guarantees some future for the region's coal.

"We have been hoping and looking for infrastructure legislation," said Harry Childress, president of the Virginia Coal and Energy Alliance in Lebanon, in the heart of coal territory 40 miles south of Grundy. "That could put steel production in the United States back online."

Philanthropy from the McGlothlins, the Streets and the other baronial families that minted fortunes from Buchanan's coal have helped fund projects in the area, including the law school and the college of pharmacy. Though dwindling, coal revenues can provide resources for the community's diversification. Coal-related tax revenues, including property taxes and severance taxes imposed on the extraction of coal, are not what they once were. But they remain an important source of county funding. A share of severance taxes goes to the Virginia Coalfield Economic Development Authority, which funds Industrial Development Authority projects. The authority has funded broadband development in Buchanan County and a logistics and transportation center in Southern Gap.

Shannon Blevins, associate vice chancellor for economic development and engagement at the University of Virginia College at Wise, 60 miles from Grundy, says she is optimistic about the diversification initiatives in southwestern Virginia. She puts a lot of hope in the university's computer-science and software-engineering graduates, who might draw the interest of high-tech firms worried about labor costs in bigger cities.

Tourism is another promising option. There are efforts to develop forest products and crops like hemp in the region, and even to identify abandoned coal mines that could house data centers, taking advantage of the low underground temperatures to keep them cool.

"This is a great time to invest in southwestern Virginia," Ms. Blevins said.

And yet her optimism contrasts with the more jaundiced views of many residents. "There has been a ton of money spent in Buchanan County through grants," said Mr. Ward, now in construction. "Not one penny has provided a replacement job for coal workers."

He admits he doesn't have good alternatives to their "pie-in-the-sky ideas," but wonders, "How can you replace $30-an-hour jobs in the mines with mom-and-pops renting little cabins and paying $8 an hour?" His business has "not made any real money since 2011."

The big call center on Southern Gap closed in September, cutting nearly 200 jobs. Mr. Ward is sure that 10 years from now, Walmart will have left Grundy.

Mr. Ward, 50, often shares breakfast with a rolling cast of septuagenarian veterans from the mines at the Dairy Queen on U.S. 460. There is Jim Hill, who left the mines to become a preacher in one of the county's many Church of Christ congregations, remembering how in the old days people could retire from the mines with $1 million in their pocket. There is the guy they call "Honest Moe," counting all the local businesses that have closed in the last few years. Together, they painted a complicated picture of the lives coal supported: dangerous but prosperous. Overwhelmingly, they support President Trump, who promised to bring coal back. But it doesn't look as if they have much faith in the promise. As Hoot Dellinger said, leaning over the edge of his booth, "This community will never prosper again."

Without prosperity, who will stay? "Ninety percent of the girls become nurses and leave," Mr. Ward said. "We've seen a lot of guys chasing gas up in the Marcellus Shale." But even moving doesn't always work out. As shale jobs there have waned, Mr. Ward added, "a lot of them are trying to come back, and there's nothing to come back to."

Ms. Blevins acknowledges that the numbers can look bleak. But "people have to look beyond the numbers," she said, and tease out the opportunities. "I want our region's children to have the opportunity to stay."

# data[].attributes.attachment_link.description
A coal town in southwestern Virginia has been trying for years. Hope is running thin. The SunCoke Energy plant near Grundy, Va., the seat of a county where mining once provided 5,000 jobs. Credit... Julia Rendleman for The New York Times GRUNDY, Va.

# data[].attributes.attachment_link.title
Grundy coal company owner sentenced to 3 months in jail for dust-sampling fraud

# data[].attributes.attachment_link.description
A Grundy coal company owner must serve three months in federal prison after he pleaded guilty to conspiracy to commit dust-sampling fraud. Daniel Tucker, 57, the owner of D&H Mining was sentenced Tuesday, according toUnited States Attorney Thomas T. Cullen. Gerald Ball, 39,a foreman at D&H Mining, was sentenced for his role in the conspiracy to three years of probation.

# data[].attributes.attachment_link.readable_text
From Men's Health
IN A NARROW SHADOW of land between two steep mountainsides in West Virginia, residents of a town called Minden are dying. Not in that existential "we're all dying a little bit every day" way, but in the blotchy-lesions-and-tumor-riddled-organs-that-eventually-stop-working way.

The 250 residents are all that's left of a community that peaked at about 1,200 in 1970, and they think they know what's picking them off one by one, in a relentless, who's-next roulette. They can't avoid it in their homes. Or in their backyards. Or on the grounds of the abandoned factory where kids ride their dirt bikes. Locals have taken to calling Minden's main road "Death Valley Drive."

Annetta Coffman has lived on this land for all of her 44 years. But in 2018 alone, 15 of her neighbors, people from age 12 to almost 90, died of cancer. That's a full 6 percent of the town's current population. "That year was a nightmare," she says, her voice more tired than sad a year after the fact.

Coffman lost her mother to breast, cervical, and uterine cancer in 2007. About five years ago, doctors discovered a tumor on the pituitary gland of her son, Dalton Kincaid. He'd stopped growing at four-foot-eleven and couldn't keep on weight, even if he ate 5,000 calories a day. His doctor told him he had to quit basketball, the sport he lived for, because he couldn't afford to burn extra calories. "My doctor said he didn't even want me to play basketball with my friends," Kincaid says. No pickup ball, no messing around on the court on weekends.

Coffman recounts what they've been through matter-of-factly, but her voice trembles with anxiety. Treatments shrank Kincaid's tumors, yet despite a diet of 3,000 to 4,000 calories per day, even now, at age 20, he's still extremely lean. High energy and fast talking, he explains that he holds down a job at Walmart while going to school full-time at West Virginia University Tech. But recently he's been hit by blinding light sensitivity, and lately his eyes have been inflamed, "like he's having an allergy attack," his mom chimes in.

Coffman works two jobs in town, one at a chiropractor's office and the other waiting tables at a restaurant. Minden is home, but she and the other remaining residents are desperate to move. Because they're sure they'll die sooner if they stay. Ayne Amjad, M.D., an internist who lives 24 miles away and has become an advocate for the people of Minden, says her research estimates the cancer rate to be about 80 percent for those who've spent the majority of their lives in this valley.

Minden is a verdant place where Arbuckle Creek, the stream that carved the valley to begin with, runs between and behind its homes. The trouble is that when it rains, the water has nowhere to go but up. The creek bucks its banks "maybe four, five, or six times a year," says Coffman. "And when it floods," Kincaid adds, "it runs for days." When the waters recede, there's sediment. In the riverbed and on the roads. In yards, in basements, in homes. Residents think that sediment, which is contaminated with leftover industrial chemicals, is what is making people sick. It's what they believe has poisoned three-going on four-generations. For more than 30 years, the people of Minden have begged for help: from the state, from the feds, from anyone who will listen.

In 2017, due to their pressure, or just the way the cards flipped, the Environmental Protection Agency came to collect soil and sediment samples to determine whether Minden should be put on the National Priorities List, a government punch list of 1,335 places that have been evaluated and deemed hazardous and that require cleanup. In 2019, the townspeople felt they'd finally found an escape route when Minden was added to that list. They hoped to get moved, thinking relocation would offer a new start, as it has with other toxic sites.

"Relocation was our goal," says Dr. Amjad. Brandon Richardson, a member of the Minden Community Action Team, says the news had people talking about the logistics of relocation, like whether they'd move as a group or take individual buyouts and each go their own way. But an October 2019 meeting with the EPA put residents back to where they've been for 30 years: waiting. "The EPA wouldn't even discuss relocation," Coffman says. Now Minden is in limbo, the townsfolk hoping to live long enough so that when the government finally acts, some people will be left to benefit.

It's a tough time to be a resident of a toxic community. From Minden to the Navajo Nation-places large and small, coastal and not-America is dealing with the health fallout of industrial pollution. Since 2016, the federal government has proposed rollbacks on 85 environmental regulations. A number of these have gone into effect, and one in particular makes it easier for coal companies to pollute nearby streams. In addition, the government's 2018 budget slashed funding for remediation at Superfund sites-the term for locations deemed so toxic they merit federal dollars-by 30 percent. From Love Canal (one of America's first Superfund sites) to the Gulf of Mexico (site of the 2010 Deepwater Horizon oil spill) to Cancer Alley in Louisiana, there's a long history of industry burying toxic waste in American backyards and of residents having to raise hell to get it cleaned up. For Coffman, the sadness inside her at some point shifted to rage. She's been holding on to that anger ever since, and joining forces with other people in and around town to try to do something about their plight.

Burying the Trouble

WHEN THE NOW-DEFUNCT Shaffer Equipment Company started refurbishing electrical equipment for mining companies in the 1970s and '80s, Coffman was just a child. In much of West Virginia, coal keeps the lights on, and mining-adjacent businesses, like Shaffer, were welcomed in rural communities.

But at Shaffer headquarters, bosses were making decisions with far-reaching consequences: Something had to be done with the used transformers and oil. The company reportedly tasked employees with dumping the oil, which they did at several sites around town, including an old mine. Used oil was also repurposed by the company and local residents as heating fuel, and it was even sprayed on dirt roads to keep the dust down.

Later it was discovered that the oil was contaminated with PCBs (polychlorinated biphenyls), heat- and pressure-resistant chemicals primarily used as insulating fluid. But those chemicals are also connected to birth defects, stillbirths, and cancer. Based on that and on the fact that PCBs can take a very long time to degrade in the environment, in 1979 the EPA ruled them a toxic substance and banned their manufacture. By then, however, the waste was all over Minden, and it was continuing to spread-in the soil, in the water, and everywhere the water went every time the creek overflowed.

Minden is so small that it doesn't have its own doctor. But in the early '80s, in nearby Oak Hill, oncologist Hassan Amjad, M.D. (Ayne's father), began noticing that a disproportionate number of his cancer patients were from Minden. He raised an alarm first with the West Virginia Department of Environmental Protection and then at the federal EPA. Soon federal employees in hazmat suits were tromping through Minden, testing various places around town, including the site of the Shaffer Equipment Company. The EPA discovered that one sample, from 4,000 cubic yards of oil-soaked soil, was contaminated with PCBs-which can leach into groundwater or be inhaled. The level in the sample was 260,000 parts per million. The EPA's acceptable limit for those chemicals in soil is one part per million.

Minden residents asked the EPA to conduct a community health study, but the agency investigator's response was that "studies of similarly exposed populations in the U. S. had not resulted in elevated PCB blood levels."

So the elder Dr. Amjad started collecting as much data as he could on his own. The problem with chemical-related cancers, especially those associated with PCBs, is that causation can be tough to prove definitively. (The kinds of cancers that PCBs seem to be linked to are the most common forms in the general population, such as lung, colon, and breast.) This makes it easy for public-health officials to say, Look at the town's smoking rates. Look at the residents' diets. Look anywhere but at the chemicals. In fact, when West Virginia state senator Stephen Baldwin recently asked a state official about health in Minden, "they said that if there are public-health problems here, it's because of people's poor choices," he says.

But even without a health study, the town had the EPA's ear for a minute in 1984. That December, agency workers arrived touting a new technology that would help break down the PCBs. It didn't work. The chemicals remained. So the EPA moved to plan B. It would truck out tainted soil and build a berm along Arbuckle Creek to prevent the migration of any remaining PCBs at the Shaffer site.

Percy "Eddie" Fruit, 65, a longtime resident whose home is within sight of one of the EPA cleanup locations, remembers watching trucks roll through town. At first, residents-including Fruit and Coffman-thought the EPA had done its job. So did the EPA. In December 1988, an agency team inspected the completed work and declared that "the restored site area remained in excellent condition and that no threat to public health or the environment existed." Not quite.

After the Cleanup

THE PEOPLE OF MINDEN were supposed to move on with their lives. And they did. Coffman had a family. Fruit worked as a pipe fitter installing sprinkler systems. He took care of his two daughters and spent his weekends and his spare cash fixing up the home he grew up in.

But as the years passed, the residents kept seeing signs that maybe the job hadn't been finished. A cache of barrels lingered on the old Shaffer Equipment Company site. And they weren't empty.

Yet all the while, people let their kids ride their bikes there, thinking it was safe, because the area hadn't been properly fenced off. Both residents and the EPA would later discover that the constructed berm isn't effective if it's being eroded by the constant flooding that happens every time the skies open up.

The town organized and sent letters to the EPA and to state and local representatives, and the agency came back to Minden in 1991 and '92. Things were looking up even more in 1993, when the EPA tried to hold Shaffer accountable by suing the company to recoup the costs of cleaning up the town.

But more dirt was uncovered: The suit was thrown out of trial court because the man the EPA had put in charge of the cleanup turned out to have lied to his employer. He didn't have the college degree or the master's degree in organic chemistry he'd claimed. The EPA appealed and the parties ultimately settled, with Shaffer paying $600,000 to partially offset the agency's costs, now well into the millions. Minden isn't suing Shaffer, since there's no money to be had. (Shaffer has since filed for bankruptcy.)

And the town can't sue the EPA at this point. Suits typically can't be brought to challenge an EPA remedy at a Superfund site until that remedy has been finalized. "Once the EPA has selected a remedy, then anyone who has standing could challenge the remedy and say it's not good enough," says Kenneth Kilbert, an environmental-litigation expert at the University of Toledo College of Law. In Minden's case, the EPA is still determining what the final remedy will be. And that's not as simple as it sounds. The agency works on reducing risk to an acceptable level, not eliminating it, Kilbert says. "From a risk perspective, that makes sense. But not if you're the person living next to it."

Fruit and his neighbors would agree with that. Even after additional cleanup in the early '90s, some of the residents still felt as though something wasn't right. Fruit noticed that people around him kept getting sick. "I had a bunch of neighbors pass away from cancer," he says. His gut told him that the danger had not passed. Soil samples tested in 2017 showed he was correct. The toxins are still there. And the residents are, too.

Establishing a Link

IT'S STARTING TO LOOK like no one is going to save Minden except the people who live there. The residents are trying to draw a direct line between what's happening to their health and what happened to their town. For more than 30 years, the elder Dr. Amjad pushed to gather as much data as possible showing the effects of PCBs on Minden residents.

Proving causation between a chemical and a type of cancer can take years and many more dollars than Minden has. But Dr. Amjad thought he was close to discovering a new type of lymphoma linked to PCBs when he died suddenly of a heart attack in 2017, says his daughter, Ayne. She has her own medical practice, and although her father had always jokingly told Minden's residents that she'd someday take over his advocacy work, she wasn't expecting to step in so soon.

But in the weeks after he died, while she was still processing her grief, "everyone started calling," she says. "They didn't know what to do and thought everything he did would be lost." When she had the strength to go into his office, she began sorting through decades of paperwork.

She hasn't been able to prove the lymphoma connection yet, but she has added two other strategies to the town's fight.

The first is an effort to get the state to help collect more accurate cancer data. The second is a plan to look beyond the EPA for a solution.

Despite the fact that Minden is on the National Priorities List, the state's Department of Health & Human Resources, which oversees the West Virginia Cancer Registry, says that its current data does not support the existence of a cancer cluster in the town. That's largely due to how the data is gathered. If you live in Minden your whole life but move and are diagnosed with the disease while living elsewhere, you will no longer show up as a cancer case related to Minden.

The younger Dr. Amjad worked with Senator Baldwin to introduce legislation to change that, but the Health Department pushed back, saying it would be too complicated to sort the data any other way but by where people lived at the time of diagnosis. The necessary information can't just be pulled from basic medical records. To collate the data by where residents lived most of their lives would require in-person interviews, which the cancer registry doesn't have the manpower to conduct.

This means that a lot of cancer cases aren't counted. Fruit's mother, who cleaned the Shaffer Equipment Company offices, died of cancer in 1992. She counts toward Minden's total. But his three brothers, all of whom have had bouts of cancer that they have so far survived, don't, because they moved away.

Fruit doesn't really like talking about cancer, because it's been too much of a presence among the people around him. Whenever the phone rings, he gets a pang of worry about what kind of news he'll be getting. Rather than talk about cancer ("If I speak, it's going to happen," he says), he prays. And then he gets busy. "You have to put your faith into action."

Stepping Up and Out

ON A HOT JUNE morning last year, Fruit got out of bed early and headed to Minden's small community center. "I'm always in pain," he says with a dark chuckle, referring to his hip, which is badly in need of a total replacement. He knew the uphill, mile-plus hike out of the valley that Minden sits in would cause misery tomorrow. But that was tomorrow's problem.

Thirty years ago, on an equally muggy June weekend, Lucian Randall, a local activist, led a march out of Minden to protest the valley's pollution with PCBs. Randall pushed an oil drum-like the ones full of PCB-contaminated oil that were dumped all over this town-up one of Minden's hills.

Fruit was a young man then, off serving in the Army, but his mother kept him informed about the fight back home. He never thought that three decades later, as a 65-year-old man, he'd be leading a march up the same hill protesting the same thing. But here he was, bad hip and all.

The march was supposed to draw attention to Minden's ongoing plight-and nod to the pilgrimage its residents hope to someday take, marching up and out of their toxic town, when they get the funds to relocate.

In one response from the EPA, last November, the agency stated that "at this time, the environmental data/risk does not show that relocation is an appropriate response action." Dr. Amjad is helping the town look elsewhere for a solution. She's investigating whether the consistent flooding in Minden at least qualifies residents for some level of disaster relief from FEMA.

But for now, they're still trapped. Living on waste has made their homes worthless. Fruit says he's put $60,000 into his home over the years. Its value today is just $38,000. Coffman owes $20,000 on her double-wide mobile home, which is too damaged from flooding to move. "So I'm either going to leave it and be in debt, or just stay until it's paid off." That would be in another ten years-which is ten more years of chemical exposure.

Even if the elusive relocation happens, that still wouldn't be the end of it. The residents would have to decide if they want to move together as a community, with neighbors staying neighbors in a brand-new development built just for them, or if everyone would rather take a cash buyout for their home and start over wherever they wish.

Coffman prefers the latter. "We're going to get cancer," she says. She's spent the past 30 years raising money for people who can't afford funerals; she's been going to memorials, making casseroles for friends, planning candlelight vigils, and watching people she loves die. If all her neighbors relocated together, it would be more of the same. "We've been exposed to it for too long. People are still going to be dying. And I don't want to see that."

Kincaid doesn't want to leave. But after he graduates from college-where he's studying criminal justice, hoping to go to law school-he'll be moving on. "If I have kids one day, I don't want them to grow up here," he says. The only way he'll find himself back in Minden is if, by the time he's passed the bar, things still haven't changed. By that time, though, he'll be armed with a law degree.
You Might Also Like

# data[].attributes.attachment_link.title
The West Virginia Town Where Everyone's Dying and the Land Is Toxic

# data[].attributes.attachment_link.description
From Men's Health IN A NARROW SHADOW of land between two steep mountainsides in West Virginia, residents of a town called Minden are dying. Not in that existential "we're all dying a little bit every day" way, but in the blotchy-lesions-and-tumor-riddled-organs-that-eventually-stop-working way.

# data[].attributes.attachment_link.readable_text
Donald Trump was more popular in McDowell County than anywhere else in America during the Republican primaries. Paul Lewis and Tom Silverstone explore the power of the Republican presidential nominee's message in the poorest county of West Virginia

# data[].attributes.attachment_link.title
Why the poorest county in West Virginia has faith in Trump - video

# data[].attributes.attachment_link.description
Donald Trump was more popular in McDowell County than anywhere else in America during the Republican primaries. Paul Lewis and Tom Silverstone explore the power of the Republican presidential nominee's message in the poorest county of West Virginia

# data[].attributes.headline
Head of George's Branch is about living life from the land, poverty and peacefulness.  It is an enjoyable film I recommend this film for those who haven't been to Appalachia.  

# data[].attributes.subject
Head of George's Branch is about living life from the land, poverty and peacefulness.  It is an enjoyable film I recommend this film for those who haven't been to Appalachia.  

# data[].attributes.attachment_link.description
Short film by Whitney Beverly and Herb E. Smith for the Side by Side Project.

# data[].attributes.headline
My cousins, The Jacksons, singing bluegrass gospel 

# data[].attributes.subject
My cousins, The Jacksons, singing bluegrass gospel 

# data[].attributes.attachment_link.title
Bluegrass, The Jackson Family, Just one more time.mpg

# data[].attributes.body
Getting baptized in the river

# data[].attributes.headline
A lot of people have never had a good doctor who was easily accessible. 

# data[].attributes.subject
A lot of people have never had a good doctor who was easily accessible. 

# data[].attributes.attachment_link.readable_text
I drove from one of the healthiest counties in the country to the least-healthy, both in the same state. Here's what I learned about work, well-being, and happiness.

Donald Rose has no teeth, but that's not his biggest problem. A camouflage hat droops over his ancient, wire-framed glasses. He's only 43, but he looks much older.

I met him one day in October as he sat on a tan metal folding chair in the hallway of Riverview School, one of the few schools-few buildings, really-in the coal-mining town of Grundy, Virginia. That day it was the site of a free clinic, the Remote Area Medical. Rose was there to get new glasses-he's on Medicare, which doesn't cover most vision services.

Remote Area Medical was founded in 1985 by Stan Brock, a 79-year-old Brit who wears a tan Air-Force-style uniform and formerly hosted a nature TV show called Wild Kingdom. Even after he spent time in the wilds of Guyana, Brock came to the conclusion that poor Americans needed access to medical care about as badly as the Guyanese did. Now Remote Area Medical holds 20 or so packed clinics all over the country each year, providing free checkups and services to low-income families who pour in from around the region.

When I pulled into the school parking lot, someone was sleeping in the small yellow car in the next space, fast-food wrappers spread out on the dashboard. Inside, the clinic's patrons looked more or less able-bodied. Most of the women were overweight, and the majority of the people I talked to were missing some of their teeth. But they were walking and talking, or shuffling patiently along the beige halls as they waited for their names to be called. There weren't a lot of crutches and wheelchairs.

Yet many of the people in the surrounding county, Buchanan, derive their income from Social Security Disability Insurance, the government program for people who are deemed unfit for work because of permanent physical or mental wounds. Along with neighboring counties, Buchanan has one of the highest percentages of adult disability recipients in the nation, according to a 2014 analysis by the Urban Institute's Stephan Lindner. Nearly 20 percent of the area's adult residents received government SSDI benefits in 2011, the most recent year Lindner was able to analyze.

According to Lindner's calculations, five of the 10 counties that have the most people on disability are in Virginia-and so are four of the lowest, making the state an emblem of how wealth and work determine health and well-being. Six hours to the north, in Arlington, Fairfax, and Loudoun Counties, just one out of every hundred adults draws SSDI benefits. But Buchanan county is home to a shadow economy of maimed workers, eking out a living the only way they can-by joining the nation's increasingly sizable disability rolls. "On certain days of the month you stay away from the post office," says Priscilla Harris, a professor who teaches at the Appalachian School of Law in Grundy, "because that's when the disability checks are coming in."

Just about everyone I spoke with at the Grundy clinic was a former manual worker, or married to one, and most had a story of a bone-crushing accident that had left them (or their spouse) out of work forever. For Rose, who came from the nearby town of Council, that day came in 1996, when he was pinned between two pillars in his job at a sawmill. He suffered through work until 2001, he told me, when he finally started collecting "his check," as it's often called. He had to go to a doctor to prove that he was truly hurting-he has deteriorating discs, he says, and chronic back pain. He was turned down twice, he thinks because he was just 30 years old at the time. Now the government sends him a monthly check for $956.

Each classroom at Riverview School had a different specialist tucked inside-in one, an optometrist measured eyes with her chart projected on the classroom wall. She showed me a picture she took in a nearby town of a man who, unable to afford new glasses and rapidly losing eyesight, had taped a stray plastic lens over his existing glasses. The clinic had brought along two glasses-manufacturing RVs where technicians could make patients like Rose a fresh set of glasses, including frames, in just a few hours.

As for his teeth? Rose's diabetes loosened them. "They went ahead and pulled them all," he said. He assured me that being toothless was not as grave a life-change as the toothed might imagine it to be.

"I can still eat a steak, trust me," he says. "I use my tongue and my gums."

AP

Grundy, which is located at the tip of Virginia that jabs into Kentucky, is sheltered by the steep, wooded Appalachians and cut through by the mighty Levisa Fork River. (The river is so mighty that the area has suffered nine major floods in the past century, and recently the entire town had to be relocated to higher ground.)

In October, the sun-dappled mountains blazed with red and orange as the leaves turned. If you wanted to send someone a postcard to convince them of the merits of Virginia, this would be it.

But if this place has the scenery of the Belgian Ardennes, it has the health statistics of Bangladesh. People here die about five years earlier than they should. About a third of people smoke, and a third are obese. A quarter of the people live in poverty, compared with about 11 percent in the rest of the state.

These Appalachians, many of them former coal miners, are among the nearly nine million American workers receiving disability payments today, compared with 1.4 million in 1970. Spending on the program has risen nine-fold over the past four decades. Clusters of recipients can be found from California to Maine, though as Lindner points out, the states with the highest numbers tend to be in the South and Southeast.

Critics say the program's expansion is partly driven by Americans who are perfectly capable of working but are unwilling to do so. Since the mid-1980s, government spending on the elderly and disabled has ballooned, even as tightened eligibility rules have slashed welfare aid for needy mothers and children. Even advocates of "big-government"-style welfare acknowledge that some people use the program because it's the only form of income available to them. At the clinic, people who were themselves on disability complained about others who they saw as lazy fakers who milked the system.

But visiting a place like Grundy reveals a more complicated picture. There are undoubtedly some who exaggerate their ailments in order to collect their checks. But many of the coal workers here have experienced horrific on-the-job accidents and can't go back to the mines. Other residents have been battered by diabetes, obesity, and tobacco. Others still suffer from severe depression and intellectual disabilities that would preclude most kinds of work. And most importantly, there are no other options here: no orthodontist's office where someone can work the front desk; no big firms brimming with entry-level secretarial jobs. It's not even clear how a person would go about calling around for a job here: My iPhone stopped working a few miles outside the county line.

Few white-collar people understand the degree to which manual labor chews up workers' bodies. And in Grundy, there's nowhere for them to go afterward.

"Here you have a Pandora's box of every social issue that might contribute to disability," said Martin Wegbreit, the director of litigation at the Central Virginia Legal Aid Society. Before coming to Richmond in 2004, Wegbreit worked in southwest Virginia for nearly 20 years.

"These are jobs that even if they don't injure people, they wear people down," he told me. "It's hard on the back, it's hard on the knees, it's hard on the entire body."

As I drove around Buchanan, trailer homes seemed to be the predominant form of housing. I passed a Dairy Queen, a Long John Silvers, a Pizza Hut, and not much else. Locals blame the town's economic slump on the decline of coal, which they in turn blame on the Environmental Protection Agency's regulations. Several yards were dotted with campaign signs urging passers-by to "Stop Obama/Vote Gillespie." (Sixty percent of Buchanan county voted for Ed Gillespie, the Republican candidate for Senate, though he lost in the state overall.)

The place had its boom years. Coal first came in the 1930s, displacing poor farmers who tilled the tough mountain dirt. In the 1970s, United Coal expanded rapidly by snapping up cheap land all across Buchanan county. A 1978 New York Times article describes a "never-ending rush hour" on Grundy's lone highway as convoys of coal trucks with names like "The Lord Is My Leader" roared through town. The Island Creek Coal Company made plans for a development of 1,600 Swiss-chalet-style houses on a nearby hilltop.

The population of the county has shrunk by about 15,000 people since that year. In May alone, 188 workers were laid off in a mine near Grundy. The industry has been slammed by the newfound natural gas reserves and is expected to contract further by 2020. Still, coal remains the largest private employer in Buchanan, and its heavy impact continues to be felt even by those who no longer work in the mines.

Though we sometimes associate the dangers of coal with big, splashy incidents like 2010's Upper Big Branch Mine Disaster in West Virginia, in which a violent explosion killed 29 men, most coal-induced disabilities are banal, and some are hard to detect. Among the most dangerous types of coal environments is low coal-so called because the seams are just 36 inches high. Workers in these mines spent their days crawling through the vast, dark caverns. "For a miner who avoids being crippled, burned or buried alive," wrote John C. Tucker of Buchanan county in May God Have Mercy, "the usual question is which will give out first-his lungs, his back, or his knees."

All types of mines require incessant bending and lifting; a bag of rock dust can weigh up to 50 pounds. Many of the former miners I spoke with complained of back pain, a condition that's both excruciating and difficult for doctors to diagnose. There's also plenty of hearing loss, says John Gifford, a local disability attorney. "It's loud as hell down there."

Other injuries are even more gruesome. "I've had men who had their hand trapped, fingers crushed, fingers amputated," Gifford adds. "One man didn't duck in time, so a cable pulled him off the mining car and he suffered paralysis in both legs." Harris, the law professor, says a former student of hers worked as a coal miner until he was trapped in a collapse and had to have his foot amputated.

In the school's cafeteria, I met a middle-aged man named Robert who told me he began working in the mines when he was 8 years old to help his family. (He asked me to use only his first name.) In 1999, he and some co-workers were repairing a piece of machinery and a metal chunk the size of a small table swung off a hook and came crashing down onto him, taking the entire apparatus down with it.

"My forehead hit the ground, and the metal hit the back of my head," he said. "I had a hard hat on. The first time it hit me, it knocked my hard hat off. The second time, it knocked my head into the ground and landed on top of me and bent me over."

After the initial recovery came the bad headaches and the prescription painkillers that he couldn't tolerate. An x-ray revealed a herniated disc. He tried to go back to work three times, he says, but after four or five days back on the job, he'd be puking from the pain. It took him five years to get his disability check. He now says he and his wife make about $2,000 a month from disability.

"We were within two, three days of losing our home," his wife, Vicki, said. "If he hadn't got it when he did, we would have."

Vicki was also applying for disability after quitting her job as a nursing assistant. Years of lifting 300-pound men, she said, inflamed the arthritis and bone spurs in her spine. She doesn't have health insurance, which is why she comes to clinics like this. The couple had been there since 4 a.m.

Working in a mine has gotten safer over the years. But even if a coal worker manages to escape a freak accident, standing in clouds of coal dust can be treacherous for the lungs over time. In a back room of the elementary school, I met with Joe Smiddy, a retired pulmonologist who now volunteers for Remote Area Medical doing chest x-rays.

He showed me an image of a pair of lungs mottled with tiny white specks-each of them a piece of coal dust with a scar around it. This is coal workers' pneumoconiosis, or black lung disease. "This gentleman has a lung full of dust," he said.

Coal workers are supposed to be offered masks to wear, Smiddy said, but "for a 12-hour shift in a coal mine, there's almost nobody who can wear a mask. They say, 'It's heavy on my face, I can't breathe with it on.'"

No matter how much gunk is clogging their airways, Smiddy said his patients often avoid complaining to their bosses or letting on that they're sick. Unless, that is, they're ready to go on disability.

"Coal mining is the only job available to them, and they're feeding their family," he said. "They're going to not raise any sand."

Compare all of this with Arlington County, 400 miles away in the northern part of the state, which has one of the nation's lowest rates of disability. Only 1 percent of people in Arlington are on disability, and it's regularly ranked one of the overall healthiest (and richest) counties in the nation. Here, there are well-paved bike routes and a Metro-accessible Whole Foods. People complain when they can't take their tiny dogs into Starbucks.

Virginia, in other words, is a state divided not only by politics, professions, and mountains, but also by how run-down its citizens are. While Buchanan county's fortunes have been inextricably tied to coal, those of Northern Virginia are hitched to the government. A large portion of its residents belong to the vast army of contractors, lobbyists, lawyers, PR people, and other auxiliary workers who orbit the federal government and rake in generous salaries for their efforts. As Dylan Matthews pointed out in the Washington Post, there's been a $1.7 billion increase in lobbying spending between 1998 and 2010 alone, which correlates neatly with the rise in incomes of Washington-area residents.

What's more, the eye-popping growth of contracting in the 90s that was intended to downsize the government resulted in private workers doing the same work for exponentially more money. Northern Virginia counties are now home to these wealthiest Washingtonians.

One day recently I visited an Arlington lululemon. Inside, a man gazed at a wall of "performance" tank tops selling for $58. He hailed a beanie-clad associate and said he needed help finding a gift for his girlfriend.

She does "something with a machine," the boyfriend said.

"Pilates?" he associate offered.

"Yeah."

"Do you know which size she is?"

"I'm going to guess," the boyfriend said confidently.

"Sounds good. If you see a girl behind the counter who you think might be the same size as her," the associate offered, "they have no problem with you asking."

Unsurprisingly, Buchanan county has no similar high-end shops. In 2011, it got a Wal-Mart that employs 230 people. At minimum wage, an entry-level job there pays as much as disability would, but even retail jobs require standing for long hours. I searched Monster.com for jobs nearby, and most of the 78 listings were in retail or home healthcare. Only two of the positions were actually in Grundy.

"We have no factories, we have nothing here," said Celeste Barrett, a social worker in Grundy. "Coal mining is all we have." Barrett was one of two women from the local department of social services sitting in front of tables bearing heaps of donated clothes. The goods were destined for the families of out-of-work miners, they said.

"If you make any money in Buchanan county, you're a coal miner," said the other woman, Amanda Coleman. "These coal miners who were making $80,000 to $90,000 and they go down on disability, where a household of one gets $1,200 [per month]."

"It's just such a hard job," Barrett added. "By the time they get a certain age, most of them are humped over."

An outmigration of the young and talented has left behind an aging population that is ill-equipped to deal with a changing economy. Thirty-two percent of Buchanan's residents never graduated from high school, compared with 15 percent nationwide.

What's more, the same landscape that makes the area so gorgeous can also, perversely, make it harder to stay healthy. Compared with large Virginia cities, Buchanan has fewer roads, sidewalks, and modes of public transportation, health workers said.*

The health problems cascade from there. The economy is built on physically grueling jobs. An injury causes pain, which causes depression. Depression makes it harder to work. People gain weight. The weight gain leads to sleep apnea and sometimes to diabetes. Diabetes can exacerbate vision problems.

To top it all off, there are few doctors in the region, and Virginia rejected the Obamacare Medicaid expansion, which would have insured an additional 170,000 people. Because getting to a doctor is hard and expensive, people self-medicate with prescription painkillers, alcohol, and tobacco. Eventually, said Smiddy, the pulmonologist, "they become dysfunctional. They're weaving behind the car. They're setting the stove on fire. It's not that they're bad people. They're probably faith-based people, family people. Most are just trying to function."

Those who argue that the disability system has become choked with exaggerated claims are not entirely wrong. In 2011, the Wall Street Journal reported on David Daugherty, a West Virginia judge who had seemingly rubber-stamped approval for all but four of the 1,284 disability appeals that came before him. He appeared to be colluding with a lawyer named Eric Conn, who had advertised his services on billboards as "Mr. Socialsecurity" and sometimes brought "an inflatable replica of himself to events." It's faster for disability judges to approve a disability claim than to reject one, so it's easy to see how less-than-deserving cases would sneak through.

Because of rising income inequality, poor people can now earn almost as much on disability as they can at minimum-wage jobs-as long as they can prove they're sick enough. In a 2006 analysis, the economists David Autor and Mark Duggan found that the main reason disability rolls have swollen is that the program's rules were liberalized in 1984. The Social Security administration was directed to weigh applicants' pain and discomfort more heavily and to relax its mental illness screening. (The government has four different sets of standards: one for people under the age of 50, another for those between 50 and 54, another for 55-59-year-olds, and a final one for those 60 and older.)

To sign up, applicants first state their disabilities and the names of their doctors. Each application is reviewed by state officials and sometimes by an independent doctor. Two-thirds of applicants are rejected after this step because they lack medical documentation that their ailments will keep them out of work for at least a year. From there, an applicant can appeal, and a different official will review his or her paperwork. After that, another 11 percent of applications are approved.

The rejected cases are seen by administrative judges in courtrooms across the country. According to a recent Washington Post investigation, the entire process can take years. If they make it through, beneficiaries will receive $13,740 annually, on average.

The problem is, even if society were to decide that there should be fewer people on disability, that the system has become too bloated with sneaky pretenders, it isn't clear what a fifth of the population of Grundy would do to survive. It's entirely possible that some of the town's residents are faking their disability claims, but it's hard to imagine that most of them are. People who are rolling in undeserved government dough generally don't line up at the crack of dawn to get their teeth fixed in an elementary school cafeteria.

Residents of Grundy sometimes run into problems during their legal proceedings, which take place via video chat from a courthouse over the mountains in Bluefield. The judge, who is listening to the arguments remotely, must consider age, education, and whether the applicant's skills can be transferred to another line of work. "If you are physically or mentally able to do a job, you don't meet the test for disability," Wegbreit says. "It doesn't matter if that job does or doesn't exist in your region of the country. And that job doesn't exist in Buchanan county."

Enough applications get through that disability benefits provide an economic safety net to Buchanan county residents. But the high number of recipients also depresses the area further by keeping new businesses away. Companies aren't eager to hire sick, worn-out miners.

"This area is a nightmare of disability," Smiddy says. Any company starting a business here knows that a substantial percentage of workers "are going to have dust on their lungs, they're going to be obese, they've already smoked a pack a day."

Once people get on disability, they usually don't go back to gainful employment. Though they're not counted in unemployment statistics, functionally, they become like the long-term unemployed-falling into an economic hole from which it's notoriously hard to claw out.

Employed people might think of being out of work as being relaxing, but jobs provide identity and purpose. "Whatever the job, it can give a sense of belonging, of being a contributor; an important part, however menial, of an organization with a bigger purpose, a valued part of society," wrote Tom Fryers, a visiting professor of public health at the University of Leicester in the U.K., in a recent paper. "Work can provide a structure for the day, week, and year without which life just drifts by."

Idleness, meanwhile, further depletes bodies and minds.The rate of depression is 19 percent among people who have been unemployed for a year, compared to just 10 to 11 percent for people who went without jobs for just a few weeks. Even though they don't face the same financial strains as the long-term unemployed, people on disability still suffer the negative health effects of being jobless. Researchers have also found high rates of depression among recipients of welfare, for example.

"Once you're on the couch, your muscles become weak, you're going to gain weight, you're not physically capable of going back in the coal mine," Smiddy said. A lack of work has been shown to increase the risk of premature death significantly, particularly for men.

The problem, as Smiddy sees it, isn't just that the economy is limited, or that the region's education and medical systems could use an overhaul. The county's health has been so poor for so long, he says, that locals have set their expectations too low. And once everyone-the people, their employers, their doctors, the government-accepts that bleak vision, it hardens into reality. It makes it so there's no life after coal.

"It's 'Just pull my teeth', or 'Grandpa died when he was 50' or 'Momma's already on oxygen,'" Smiddy tells me, his voice growing increasingly exasperated as he clicks through x-rays in his makeshift office. "There's a negative fatalistic attitude. We have to have an expectation of health, and seek health."
*This story originally stated, based on the recollection of Wegbreit, that Buchanan county had seen its first grocery store only recently. In fact, it has had a grocery store since 1955. We regret the error.

# data[].attributes.attachment_link.description
I drove from one of the healthiest counties in the country to the least-healthy, both in the same state. Here's what I learned about work, well-being, and happiness. Donald Rose has no teeth, but that's not his biggest problem. A camouflage hat droops over his ancient, wire-framed glasses.

# data[].attributes.body
This song always makes me think of home and how blessed I have been to have gotten out.

# data[].attributes.attachment_link.title
Patty Loveless: "You'll Never Leave Harlan Alive" (Live)

# data[].attributes.attachment_link.readable_text
ABINGDON - Sixteen people and six companies in Buchanan County have been indicted as part of what prosecutors described as a public corruption scheme in which the defendants used state and federal money earmarked for flood cleanup for their own gain.

In a case they are calling "Operation Big Coon Dog," federal prosecutors say contractors in Buchanan County paid bribes worth about $545,000 to county officials to win about $7.6 million in state and federal contracts. Some defendants made a total of about $3.2 million in cash and other benefits - including as much as $40,000 worth of raccoon-hunting dogs, according to federal prosecutor Tom Bondurant. "The floods of 2002 devastated the Buchanan County community and many of our families," U.S. Attorney John Brownlee said in a news conference in front of the federal courthouse in Abingdon on Thursday afternoon. "Virginia and the federal government provided over $8 million to help our citizens in their great time of need. Now, we learn that the very individuals who were elected to serve and protect the people were, in fact, stealing from them."

Brownlee emphasized that the investigation is ongoing and said he expects more people to be charged.

The case marks another allegation of public corruption in the county, in which members of the board of supervisors were also convicted of misappropriating funds in 1992.

"It's a sad day for America when these things happen, if they happened," said Abingdon attorney Emmitt Yeary, who is representing a minor player in the case, James Robert Estep, 55, a contractor charged with fraudulent collection of Social Security benefits. "If what the government is alleging is true, it's a very serious matter."

The bribes in the current case consisted of more than $350,000 in cash; $15,000 worth of all-terrain vehicles; tickets to see Washington Wizards basketball games, NASCAR races and University of Tennessee football games; $40,000 for coon dogs; services such as feeding the dogs and building and cleaning their kennels; and other services, federal prosecutors say.

"We start hearing stories about Ray Blankenship getting coon dogs as bribes and we can't pass that up," said Bondurant, who is prosecuting the case with Assistant U.S. Attorney Jennifer Bockhorst.

Blankenship, who served as chairman of the Buchanan County Board of Supervisors from 1999 to 2003, has already agreed to plead guilty to two counts of racketeering and one count of money laundering in the case, Bondurant said.

The allegations against Blankenship, 52, are particularly notable because he represented the area of Hurley, which was hardest hit by the floods.

Three other defendants - contractors Donald Ray Matney, 47; Terry Allen Keene, 40; and Kenneth Joseph Stephens, 48 - have also agreed to plead guilty to the same charges, Brownlee said.

They each face up to 60 years in prison and a fine of up to $1 million. No date has been set for their guilty pleas, and they did not return calls for comment.

Defendants who have agreed to plead guilty have already forfeited about $1.1 million in cash, Brownlee said.

Federal agents arrested the first defendant, Gary Ray Moore, at 6 a.m. Thursday in Wise County, Bondurant said. Moore worked as a contract employee for the Federal Emergency Management Agency and owned his own company, called B&E Construction. That company was not among the ones charged in the indictment.

All 16 defendants were arrested Thursday, made initial appearances in federal court, where they pleaded not guilty, and were released on bond. The defendants either declined to comment after their court appearances or could not be reached for comment. The companies charged are all affiliated with defendants in the case, Bondurant said.

Federal authorities learned about the scheme allegations in the process of investigating another Buchanan County case, which federal prosecutors declined to elaborate on.

Brownlee said the "underhanded dealings" began almost immediately after FEMA assigned the flood cleanup task to county officials.

In May 2002, flooding killed two people in Hurley and caused an estimated $30 million worth of damage to homes, businesses, roads, bridges and other parts of the town.

Initially, the contracts for rebuilding were supposed to be awarded to a New Orleans company, Brownlee said. But after public outcry, FEMA allowed county officials to decide who should receive the contracts, Brownlee said.

The board of supervisors had the authority to award contracts for cleanup, bridge repair and structure demolition, Brownlee said. Subject to approval by FEMA and the Virginia Department of Emergency Management, the county would be reimbursed for 98 percent of those costs, Brownlee said. FEMA was to pay 75 percent of the costs, Virginia 23 percent, and the rest would be absorbed by the county, according to Brownlee.

The county awarded $7.6 million in contracts, $5 million of which federal and state authorities have already reimbursed the county.

Blankenship never publicly solicited bids, and he hand-picked contractors to work on projects, prosecutors allege. The contractors in turn bribed him to work on the projects, federal prosecutors say.

For example, Stephens paid Blankenship about $127,000 for more than $2 million worth of awards and contracts, according to Brownlee. The contractors fraudulently increased reports about the amount of debris they were clearing to get more money, Brownlee said. And three of the contractors allegedly made $3 million from those jobs.

County workers such as engineer Kenneth Hale and county emergency coordinator David Thompson also accepted cash bribes, according to prosecutors. FEMA employee Moore also allegedly accepted cash and tickets to sports events. Moore "looked the other way" when cleanup workers exaggerated the amount of work they had performed, federal prosecutors say.

Of the at least half-dozen coon dogs Bondurant said were part of the case, at least two were worth about $15,000 each. None of the dogs, who had names such as Hairy Jr. and Echo, was seized as a result of the case, Bondurant said.

Get local news delivered to your inbox!

# data[].attributes.attachment_link.description
ABINGDON - Sixteen people and six companies in Buchanan County have been indicted as part of what prosecutors described as a public corruption scheme in which the defendants used state and federal money earmarked for flood cleanup for their own gain.