Poverty in this region has been a problem for many years but was not brought to the attention of the rest of the United States until 1964 when US President Lyndon B. Johnson delivered a speech from a sagging front porch in a poor Appalachian mining town.

In Appalachia, severe poverty and desolation is paired with the necessity for careful, cultural sensitivity. Many Appalachian people fear that the birth of a new modernized Appalachia will lead to a death of their traditional values and heritage. Because of the isolation of the region, Appalachian people have been unable to catch up to the modernization that lowlanders have achieved. In the 1960s, many people in Appalachia had a standard of living comparable to third world countries. Lyndon B. Johnson was the first president to bring attention to the growing problem of poverty in Appalachia. Standing on the front porch of a family suffering from a problem that had been so long ignored, he declared his "War on Poverty". The Appalachian Regional Development Act (1964), which created the Appalachian Regional Commission (ARC), stated that Appalachia was a shambles:

The Appalachian region of the United States, while abundant in natural resources and rich in potential, lags behind the rest of the nation... its people have not shared properly in the nation’s prosperity.

Since the creation of the Appalachian Regional Commission (ARC) in 1965, the region has seen dramatic progress. New roads, schools, health care facilities, water and sewer systems, and other improvements have brought a better life to many Appalachian residents.

In 1960, 219 counties in the 13-state Appalachian Region were considered economically distressed. Now that list has been cut in half, to 108 counties, but these are "hard-core" pockets of poverty, seemingly oblivious to all efforts at improving their lot.

Nevertheless, after 40 years poverty remains undefeated in Appalachia. Martin County, Kentucky, the site of Johnson’s 1964 speech, is currently ranked as "distressed" by the ARC. (Distressed is the worst ranking.) Martin’s average income is US$ 17,152, and 37% of its residents live below the poverty line.

On 5 July 1999, President Bill Clinton made a public statement concerning the situation in Tyner, Kentucky. "I'm here to make a simple point," Clinton told the enthusiastic crowd. "This is the time to bring more jobs and investment to parts of the country that have not participated in this time of prosperity. Any work that can be done by anybody in America can be done in Appalachia." Like Johnson, Clinton also brought attention to the areas of poverty in Appalachia. On the other hand, Republicans point to the fact that the number of children living in poverty has increased since Johnson's poverty policies in the 1960s, and while Republicans agree with the intentions of these policies they disagree about their results and efficacy.

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