Residents of Appalachian coal communities are sometimes offended by images of regional poverty. "Where are the pictures of the clean, well-parented children?" they ask. Not all the children in coal camps were on welfare, and images of Appalachian poverty can feed pernicious and destructive regional stereotypes.

Nevertheless, coal country poverty is a reality. For reasons that are debated by scholars, economies based on large-scale resource extraction, such as the coal industry, tend to correlate with high poverty rates, worldwide. So, for example, the biggest coal producing counties of Kentucky have higher poverty rates, and lower median income and lower high school graduation rates, than any of the other counties in Kentucky, including surrounding counties with no interstate road access.

In 1964, president Lyndon B. Johnson announced a set of federal initiatives called the "War on Poverty," to address persistent poverty in certain regions of the United States, including Appalachia. In February of 1968, Robert F. Kennedy visited eastern Kentucky for three days, in order to assess how well the war on poverty was helping residents of the region. (This was before Kennedy had officially announced his candidacy for president, and four months before he would be assassinated.) Kennedy concluded then that hunger and poverty were still serious problems in the region. Forty years later, while the food stamp program and care for the elderly have improved, the poverty rate in the region is exactly the same as it was in 1968. In parts of eastern Kentucky today, one out of two children live below the official poverty line.