My wife and I moved here in 2008 so I am far from an expert on things but you pretty much have seen what I see.I went to school in Barbourville, KY my freshman year and had a GF in the SW program doing an internship, and occasionally I used to go on home visit rounds with her.
I was shocked by the poverty, and alternated between amazed at the genteel nobility of some hill folks, and dismayed by the ignorance and cruelty of others.