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." And indeed, when Maimon arrived in Hazard, Kentucky fresh off a reporting stint for the New York Times's Berlin bureau, he felt every bit the outsider. He had landed in a place in the vice grip of ecological devastation and a corporate-made opioid epidemic--a place where vote-buying and drug-motivated political assassinations were the order of the day. While reporting on the intense religious allegiances, the bitter, bareknuckled 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.