“Eastern Kentucky just might be the hardest place to live in the United States.”

Rural, Eastern Kentucky has become famed as an area where the residents carve out the coal from the ground. At the same time, it’s also carved out a reputation as among the most persistently poor areas in the United States. It is so synonymous with rural poverty that President Lyndon Baines Johnson started his “war on poverty” in Inez, Ky., in the eastern region.

Unfortunately this area’s problems have not only persisted, but mutated, prompting The New York Times to do a lengthy feature in this past weekend’s magazine that asked “What’s the Matter With Eastern Kentucky?

Plenty, it turns out. “In its persistent poverty, Eastern Kentucky … just might be the hardest place to live in the United States. Statistically speaking,” wrote The New York Times’ Annie Lowry.

The Times’ data-analysis venture The Upshot compiled six basic metrics to present a picture of the longevity and quality of life in each county in the U.S. Here they are: 1) education attainment, 2) household income, 3) jobless rate, 4) disability rate, 5) life expectancy and 6) obesity rate. The six counties in Kentucky’s coal country–Breathitt, Clay, Jackson, Lee, Leslie and Magoffin–are all among the bottom 10 for all of these.

Among these, Clay County ranked as the worst of the worst, with a median household income of $22,296, just slightly above the poverty line. Only 7.4 percent have a bachelor’s degree or higher. Unemployment is 12.7 percent, and disability is at 11.7 percent, versus the national average of 1.3 percent. Nearly half the county is obese, and life expectancy is six years shorter than the national average.

There are a lot of culprits, the article says, for why life quality is so low in Eastern Kentucky. A big problem is the land itself. It might be picturesque, with rolling hills and the like, but it’s hard for trucks to navigate those hills, and it’s all remote. This sets up hurdles to any kind of economic development.

Another issue springs from this: Remote, sparsely populated areas tend to be poorer because they don’t have enough people to create a critical mass for creativity, job growth, and other kinds of economic development. “The communities are small, and they’re spread apart, so you lose that synergy that you want to spark development a lot of times,” James P. Ziliak, director of the Center for Poverty Research at the University of Kentucky, told the Times.

Also, the area’s major economic driver, coal, just isn’t what it used to be. The article reports that in 1980, 2.5 million tons of coal came from Clay County, versus 38,000 tons in 2014 so far. It’s unlikely this will ever come back.

The article makes the point that over generations, Eastern Kentucky, in between bouts of neglect, has been a test-lab for one attempt to fix poverty after another. All have failed, though federal subsistence programs at least keep the true terror of life without a safety net at least somewhat at bay.

All the same, none of the affluence of the past several decades has landed in Eastern Kentucky. “In some places … poverty has become more concentrated,” the article stated.

Kentucky Sen. Rand Paul wants to eliminate capital-gains taxes in the region and impose a special federal income tax of 5 percent in the area. But this area is hardly a hotbed of the sort of stock market-style investing that would benefit from a reduction of capital gains from 15 percent to zero. In fact, federal assistance payments, aka “transfer” payments, make up half of all income for some parts of Eastern Kentucky.

And it’s highly unlikely there is enough wealth at the top in the area where reductions in taxes will yield any real, meaningful spending.

The article raises the uncomfortable idea that maybe people should leave Eastern Kentucky if they’re at all able. There are jobs to be had in North Dakota, for example. This would take something quite big, though: for everyone to admit that there may be no real fixes for an area that has few resources, and little hope for future economic growth. The best way to save Eastern Kentucky might be to leave it.