When Alan Maimon got the assignment in 2000 to report on life in rural Eastern Kentucky, his editor at the Louisville Courier-Journal told him to cover the region “like a foreign correspondent would.” Maimon had landed in a place in the vice grip of ecological devastation and a corporate-made opioid epidemic. While reporting on the intense religious allegiances, the bitter, bare-knuckled political rivalries, and the faltering attempts to emerge from a century-long coal-based economy, Maimon learns that everything --- and nothing --- you have heard about the region is true. And far from being a foreign place, it is a region whose generations-long struggles are driven by quintessentially American forces.