In 1934, when H.W. Francis showed up in Williamson, West Virginia, just across the river from Pike County, Kentucky, he saw "worse living conditions and more cause for discontent" than he had seen anywhere. In 1964, when President Lyndon Johnson wanted to begin his War on Poverty, he did so from Inez, Kentucky, a mere 20 miles as the crow flies from Blackberry Creek and Williamson. Just last week, I read an article in The Charleston Gazette that described how, from 2006 to 2016, more than 20 million prescription pain pills were sent to two pharmacies in Williamson. We have a long history of hard times. For this book, which I hope will convey a sense of the history of those hard times, I have gathered some documents and images that relate to that time and place. There is the letter from H. W. Francis for the Federal Emergency Relief Administration. There are dozens of poignant images from the 1946 Medical Survey of the Bituminous Coal Industry. There is a chapter from a 1922 book by Robert Bruere of the Bureau of Industrial Research. We've come a long way, but there's a long way yet to go.