Appalachia After the Pandemic: A Plea for the Future

In America, the pandemic is almost over. About 131 million people have received at least one dose of the vaccine—roughly 40 percent of the population. Of 75 million fully vaccinated people, the Centers for Disease Control and Prevention found only 5,800 COVID-19 cases that broke through the vaccine. While future variants could pose a problem, the end of social distancing and mask-wearing is in sight.

The rapidity at which the vaccine was developed, and its high level of effectiveness, should be an inspiration for the country in other areas. America remains the innovation capital of the world, but stagnation and complacency are still a problem. We’re living in an era of plague, but when it passes, our leaders should strive for a better future.

In Appalachia, the pandemic has revealed the status quo was holding back the region’s potential. Telehealth has finally started to expand. Remote work has made living in rural areas and smaller cities more appealing. And amenities like new parks and outdoor recreation gives the region a boost for locals and visitors alike. With some imagination and a willingness to change, a better future is possible.

For what comes next, new ideas could make Appalachia more appealing as a place to live, either for a few years or a lifetime. Utopian visions should be rejected, but pragmatic improvements can go a long way.

Health care

Attract more doctors. Train more nurses. Expand telehealth services. State and federal lawmakers from the region should build a health care plan around these points. Offer foreign doctors work visas to come to the region and train a replacement if they leave. Alter state and federal laws to allow nurses to offer more health care services that they’re already trained to do, but are handcuffed by outdated policies from performing. And figure out how remote doctor visits can become more accessible and affordable for patients who can’t make it in person.

If it’s hard to access health care in the region, local authorities have a responsibility to get inventive. Mobile clinics and smaller health care offices run by nurses and other non-doctor health workers can bridge the gap.

Higher education

Rural higher ed has shrunk during the pandemic as public regional colleges have seen layoffs and budget cuts and community colleges have lost students. 

As rural areas shrink and urban areas grow (and rural residents age), it doesn’t make sense to expand colleges everywhere. What does make sense is to emphasize academic programs that give students little debt and good job prospects, and to lobby for more online options. Students have completed online classes for a year now—why not loosen residency requirements and give students the option of staying remote, or only require students to come on campus once or twice a week? Being surrounded by other students adds something important to the college experience, but if a student has family obligations they can’t avoid, a remote option at a far-off college could give them a choice that didn’t exist before the pandemic.

Student interest may change, or interest in apprenticeships and non-traditional education may grow, but the important thing to emphasize is access and adaptability, not conformity to the norm in other parts of the country.


The mass expansion of remote work, and the boost for outdoors recreation, gives rural areas a great opportunity. Small towns and sparsely populated counties need to seize the chance to form stronger economic bonds with large cities. Urban dwellers should be overwhelmed by billboards and subway ads from Appalachia about cheap land, great natural landscapes, and surprisingly easy connections to the city. 

County commissioners should be bothering large companies in urban areas asking about their remote work policies. Not every part of Appalachia can become Gatlinburg, Asheville, or Pittsburgh, but greater cooperation with a larger city nearby can create new economic opportunities. Slow economic growth isn’t always fixed with tax cuts (or government spending)—sometimes, new networks and connections matter more to spark a change. 


Everyone loves infrastructure spending. Spending on roads, bridges, and “shovel-ready projects” gets bipartisan support, as does expanding the definition of “infrastructure” (not everything, alas, can be called infrastructure). But, rather than expanding infrastructure, the region may be better served by avoiding new infrastructure boondoggles. 

As Charles Marohn of Strong Towns has explained, bad city and county planning means that many places have built themselves into the poorhouse by driving up maintenance costs. In too many places, the tax burden to keep the built environment in good shape is too high. Walkable small towns that embrace density will have an easier time coming up with money to pave roads, fund schools, and fix sewers than sprawling areas without the economic activity to support it. 

To attract more residents and keep locals around, Appalachian small towns need to figure out how to revive themselves after the pandemic rather than preserving the mistakes of the status quo.

Avoiding Mistakes

If one thing sells, it’s extravagant promises. Natural gas has boosted some local wealth here and there, but it hasn’t generated long-term economic growth in Appalachia like its boosters promised (or environmental apocalypse, as its detractors predicted). Nor has the population gone up. 

The same fate awaits President Biden’s American Jobs plan and the vision of an Appalachian New Deal. Though the environmental destruction of defunct coal mines and oil & gas wells need to be addressed, environmental reclamation projects will not lead to magical economic growth. Many projects to restore polluted mine lands may be worthy of funding, but to say they will spark economic growth is a bad argument. The American Jobs plan’s promise of 243,000 jobs gives the AFL-CIO a nice talking point, but it lacks credibility for all except the naïve. 

The Appalachian region has been guaranteed a jobs renaissance from the left and the right for decades—but utopian visions are no substitute for pragmatic approaches with steady results.

Appalachia’s problems run the gamut. The usual economic, health, and environmental problems are there, as is the drug trade and cultural stagnation. A status quo bias remains where it can be hard to change business as usual for all sorts of reasons. If the last year has taught us anything, it’s that “normal” is neither guaranteed nor long-lasting. But it has also shown that improvement isn’t impossible. Things can change—and for the better.

If Appalachia has a better future, it will start with people having a willingness to change the status quo (without throwing out what already works well). If revamping the stodgy bureaucracy holding back telehealth and online education has already made the pandemic more bearable, just imagine what could happen in other areas.

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Anthony Hennen is managing editor of expatalachians and managing editor of the James G. Martin Center for Academic Renewal in Raleigh, North Carolina.

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