Appalachia in general has been spat on, kicked, and left to die by the ruling class after their usefulness ran out. When everything ran on coal it was the most lucrative region in the US and the labor movement was incredibly strong. The people there voting for trump is more the result of Democrats abandoning working-class politics than anything else. Trump pretends to be a champion of the working class and promised the return of the coal industry while Democrats dismissed them as unreachable and said they would phase out what remains of the coal industry to prevent climate change. When Republicans tell them climate change is overblown and clean coal is possible they want to believe it because they want a return to "the good old days" when Appalachia was booming. Democrats could have reached out to these people and offered an alternative, but their wealthy donors wouldn't have liked any real solution and that's who the party actually answers to, not the people.
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