“He thinks our people are idiots.” You said it........ They are so stupid, they shouldn't vote, even if they do...

Trump Has Betrayed the People of Coal Country. They Love Him Anyway.

“He thinks our people are idiots.”

Stephanie Mencimer

Christy Ratliff is sitting in a folding chair in a public school gym in Grundy, Virginia, waiting for her number to be called. She arrived at 4 a.m. on this October Saturday to secure her position in line to have eight teeth pulled. Genetic gum disease, she explains, has left most of them rotten or broken. She hooks a finger to pull down her lip and show me gruesome damage—the kind most dentists see only in textbooks.

Grundy, the seat of Buchanan County, sits deep in the Appalachian Mountains of Southwest Virginia. This weekend, it’s hosting a free clinic courtesy of Remote Area Medical, a nonprofit like Doctors Without Borders, but for places in the United States where the health ­outcomes are as grim as those in many developing countries. RAM founder Stan Brock once suggested that because Grundy is so inaccessible, his volunteers should literally parachute into town, as he once did while working in rural Africa.

Buchanan County borders West ­Virginia and Kentucky. The nearest (tiny) airport is in Bristol, Tennessee, about two hours south. Nothing around Grundy is flat. The roads can be perilous and slow going. But the topography doesn’t deter hundreds of people from traveling to the RAM clinic from all over the region. Ratliff’s friend drove her about 30 minutes from her home in Haysi, population 537, in neighboring Dickenson County. Grundy, an ­isolated coal country outpost, has only one or two dentists, and even if Ratliff could get in to see them, she can’t afford to. A mother of two small children, with her ex-husband in prison, she earns $13.47 an hour working part time at Food City. Along with about a quarter of the residents of Buchanan and Dickenson counties, Ratliff is covered by Medicaid, but she hasn’t been able to find a dentist to go to. That’s why she’s here in this gym, where RAM offers free dental work.

Inside the gym are rows of clear plastic tents full of patients in dental chairs undergoing cleanings, fillings, and extractions. The providers are dental students, including at least a dozen Kuwaitis who attend Virginia Commonwealth University and volunteer dentists from as far away as Buffalo, New York. Under the basketball hoops, patients sit in plastic chairs, waiting their turn or recovering from various procedures, cheeks stuffed with gauze and lips stained with blood.

This operation is a well-oiled machine, but the dentists can do only so much in one weekend. Ratliff aims to come back for dentures when the clinic returns next year. Until then, she tells me, she’s “just gonna chew on my gums.”

Ratliff is 29 years old.

When I call a few weeks later to see how it went, she gives me an update: She called it quits after just two teeth. The dentist “just kept prising and prising,” she said. “I couldn’t do no more.” But she plans to get the rest out eventually. Her situation is not unusual in these parts. Roughly 20 percent of Buchanan County residents have no teeth at all. “That’s not something you see even in dental school,” says Dr. Kevin D’Angelo, a University of Buffalo dentistry professor who’s been overseeing the local RAM dental clinic for decades. “You just don’t get that.”

Rotting teeth may be part of an Appalachian stereotype, but they are also a visible marker of extreme poverty and a health risk in their own right. “Infected teeth cause cardiovascular disease, diabetes,” D’Angelo explains, diseases rampant in Buchanan County, nearly a quarter of whose 19,000 or so residents live below the federal poverty line. In 2015, the Atlantic dubbed Grundy “the sickest town in America.” Now it is famous for another reason: One of America’s sickest, poorest places is also one of its Trumpiest.

In 2016, Buchanan County gave ­Donald Trump his single biggest win of the national Republican primaries. He got 70 percent of the local votes, double his statewide share. He fared even better here in the 2024 general election, winning 85 percent. Ratliff has never voted, she says, but “I’m glad Trump got it back.”

Despite all the faith these locals have put in Trump, his second term is threatening their precarious existence. Few places in America are as reliant on the federal government. According to a recent study, 45 percent of the personal income of ­Buchanan County residents comes from Social Security, Medicaid, and Medicare, the Supplemental Nutrition Assistance Program (SNAP), and government disability programs. Federal dollars also account for about 15 percent of the county budget, subsidizing nearly every aspect of local life—education, economic development, disaster recovery, housing, sewer infrastructure. And Trump has succeeded in jeopardizing or eliminating nearly all of it.

“The role of the federal government in that part of America is just so core and ­fundamental,” says former Rep. Rick Boucher, a Democrat who represented Buchanan County for nearly 30 years before he was ousted in the 2010 tea party wave. “To reduce it substantially is going to create real hardship and pain.”

At 5:45 a.m. on the first day of the clinic, rows of idling cars are stuffed with people bundled against the autumn chill, eating gas station snacks and sipping coffee from thermoses. Many have been here all night. Someone is even rumored to have dropped off an Amish guy who spent the night in an adjacent field with nothing but a sleeping bag.

RAM’s free services are first-come, first-served, and latecomers risk losing out. Volunteers with clipboards wander among the cars, assigning people places in line for when the clinic opens at 6.

Mistaking me for a volunteer, a man behind the wheel of a pickup truck asks how much longer the wait will be. He and his friend have been here since 3:30 a.m. They are 60th and 63rd in line. The driver, a thin 42-year-old with a clipped beard, hails from nearby Bradshaw, West Virginia, population 207. Bradshaw is part of McDowell County, where the life expectancy is 66 years, about the same as in Sudan.

“We live in a remote part of the world,” the driver says, declining to give his name. He’s here for denture work because ­Bradshaw has no dentist. He grew up in a holler, and like generations of his people, worked in the coal industry, including once for a company owned by Sen. Jim Justice (R-W.Va.)—until his paychecks bounced, a chronic problem at Justice’s mines. Now he works in logging. He has no health insurance, he says. Like 80 percent of McDowell County’s voters, he cast his ballot for Trump: “He’s kicking ass and taking names. He’s cleaning up the gangs. He’s doing awesome with the immigrants, too.”

I ask him whether there are many immigrants around here. “Very few,” he concedes. He’s also pleased the president cut taxes on overtime, though none of the companies he’s worked for gave him enough hours to qualify for overtime. But mostly, he likes that Trump is a cheerleader for the coal industry.

Trump has been promising Appalachia he’d end the “war on coal” ever since his first campaign, then kicked off his second term with three executive orders slashing regulations and rolling back environmental protections to boost mine production. Coal companies laid off more than 300 people in Buchanan County in 2025. By the end of November, the county’s unemployment rate had shot up by 63 percent since the last month of the Biden administration.

Though Trump’s pro-coal rhetoric may win him votes, none of his incentives are likely to bring jobs back, especially given the local effects of his trade and foreign policies. The type of rare coal found in this part of Appalachia is used not for power plants but to produce steel, particularly in China. But Trump’s trade war with the People’s Republic “has resulted in the imposition of an additional 15 percent duty on US coal imported into China,” explains Andrew Blumenfeld, a coal market expert with McCloskey, a mining data analytics firm. “This resulted in almost no US coal exports to China [in 2025], with Buchanan being swept up in this dispute.”

The Russia–Ukraine war that Trump promised to end “on day one” is another factor. The parent company of Wellmore, one of the companies shedding jobs locally, is owned by the Ukrainian billionaire Rinat Akhmetov. Buchanan County coal was helping Ukraine produce steel. But thanks to the war, Ukraine is not producing much steel and has cut back on purchases of Wellmore’s pricier coal. Christy Ratliff tells me that Wellmore recently laid off her “Pawpaw.” The company is now for sale, and with no offers on the table, it may close down for good.

Buchanan County has been trying for decades to diversify its economy. Among its largest employers is a state prison that opened in 1990. But the biggest economic threat is population loss. The county now has about half as many people as it did in 1980. A recent University of Virginia study pro­jects that it will lose another 50 percent in the next quarter century. An ongoing opioid epidemic culls the county’s young—those who haven’t already left for better opportunities. The people left behind tend to be a graying and unhealthy bunch, median age 47—nearly a decade older than statewide. A whopping 35 percent of Buchanan County residents are disabled.

The Trump administration has been trying to make matters a lot worse. Last spring, for instance, the administration attempted to lay off almost all of the employees at the National Institute for Occupational Safety and Health (NIOSH), including the people running a program that administers benefits for miners stricken by black lung disease. The miners sued, and a judge ordered the administration to restore some of those jobs, but many employees haven’t returned. After intense lobbying by unions and unhappy members of Congress, the administration revoked all of the NIOSH layoff notices on January 13.

Health and Human Services Secretary Robert F. Kennedy Jr.’s proposed budget for 2026 would have slashed NIOSH funding by 80 percent this year, but in late January, Congress rejected the proposal and increased the budget by about $4 million. Trump’s Labor Department also has attempted to roll back safety rules that reduce the risk of mine collapses and other disasters.

The only meaningful benefits to mining communities had been coming, ironically enough, from the Biden administration, which in 2024 finally managed to enact a rule limiting miners’ exposure to the silica dust that causes the most severe forms of black lung, a variant that has become especially acute in younger miners. Because the most accessible coal seams are long gone, Appalachia’s miners must now bore through miles of stone, creating extremely dangerous fine particles that lodge in the lungs. But the Biden silica rule was put on hold last April after industry groups sued to block it, and the Trump administration has not defended it.

“My dad died from black lung,” says Brandi Hurley, a local lawyer and Grundy native who struggles to understand her community’s support for both coal and Trump. “I wish I could explain it in a way that made sense.”

She likes to remind Trump supporters, including family members, what he said about coal miners back in 1990: “The coal miner gets black-lung disease, his son gets it, then his son,” Trump told Playboy magazine. “If I had been the son of a coal miner, I would have left the damn mines. But most people don’t have the imagination—or whatever—to leave their mine. They don’t have it.”

In short, Hurley says, “He thinks our people are idiots.”

Back at the clinic, I take a break from watching tooth extractions to eat lunch on a sunny picnic bench near the parking area. A couple of young women approach with a clipboard: Do I have a number?

They are first-year students from Appalachian School of Law (ASL), a tiny local institution that requires students to perform community service. They clearly don’t hail from these parts. One is from New York City, the other from California by way of West Virginia, where she’d been employed as a social worker. Neither is white.

The students, who asked not to be named, are part of an underappreciated economic engine that’s helping keep ­Buchanan County afloat, but that also is imperiled by the Trump administration. Founded in the 1990s, ASL was funded in part by the Appalachian Regional Commission, a federal economic development agency that Trump has attempted to eliminate. The law school has a full-time enrollment of 182 students. Roughly a third are people of color, and many are the first in their families to have attended college.

One of the students mentions that she lives in an apartment owned by a coal ­industry worker. Renting to students is a much-needed source of income for many families, just one way the school helps the local economy.

The law school’s dean, David Western, is a retired Air Force colonel, former judge advocate general, and pastor at two local churches. He sees ASL as a major force for good in the region, with graduates going on to work as local defense lawyers and prosecutors and assume other important legal roles that are historically hard to fill. “Our real mission is to fill those legal deserts in the Appalachian region,” he told me.

Western figures his students spend about $2.4 million locally each year. “Anytime a student goes to Walmart,” he says, “they’re funding the local economy.” That figure doesn’t include the value of their volunteer work—about $50,000 a semester, he estimates­—or the local taxes paid by the school’s 47 employees.

The Trump administration is now undermining one of Buchanan County’s few bright lights. For one, the president’s so-called One Big Beautiful Bill limits the amount ASL’s students can borrow directly from the government’s low-interest loan program. It capped student loans for professional schools at $50,000 a year, with a lifetime cap of $200,000. The estimated cost of attendance (tuition plus expenses) at ASL is $82,800 a year. Some 75 percent of students rely on federal loans, Western says.

Trump claimed the cap was put in to protect students from burdensome debt, but critics counter that it is a giveaway to private lenders, who lost billions of dollars when President Barack Obama ­allowed the government to loan directly to students back in 2010, making borrowing more affordable while cutting out the middlemen—the big banks.

The new loan cap will likely force law students to turn to private—and ­potentially predatory—lenders, who enjoy minimal scrutiny now that Trump has neutered the Consumer Financial Protection Bureau and the Department of Education’s Office for Civil Rights. “I’ve been trying to figure out what we’re going to do,” Western says. “Most deans across the country are panicking.”

Trump’s megabill, Western says, also has an “accountability” provision that ties a school’s eligibility for the direct loan program to its students’ postgraduate earnings. The salaries of ASL grads, who often end up working in low-income Appalachia, may be paltry next to those of University of Virginia and Virginia Tech graduates who are more likely to secure higher-paying jobs in engineering or tech. The administration can now penalize programs with “low earnings outcomes” such that students at schools like ASL, he says, “won’t be able to take out any federal loans.”

Western is now frantically trying to raise money through grants, big donors, and even “boozy bingo” scholarship fund events. “This is so Appalachian to share this,” he says sheepishly. “People here love bingo.” The first event lost money, but “it should raise more next time.”

Clearly, boozy bingo won’t make up for the millions of dollars the school could lose in financial aid under the Trump regime. “To be honest with you,” Western confesses, “we’re a little terrified.”

Given its dire financial straits, the law school is considering a merger with ­Roanoke College—a move opposed by county officials. But to survive in Grundy, ASL desperately needs to increase enrollment, a near-impossible task if its students can’t borrow enough affordably. “If the school has to close,” Western says, “it will likely be the Big Beautiful Bill that puts the nail in the coffin.”

People originally came to Buchanan County for “moonshine,” says homegrown lawyer Hurley, who grew up on land her family has owned for 150 years and got her law degree from ASL. For its first 100 years, she says, it was the realm of outlaws. “You moved to Buchanan if you were okay gutting a federal officer who tried to take your still. Those were my people,” she tells me with a laugh. “Even the Native Americans weren’t in Buchanan County. It’s an inhospitable area.”

The topography that makes Grundy ­inaccessible also makes it stunningly beautiful. Ancient rock cliffs rise from the Levisa river, which 20 years ago ran black with coal dust. Driving in, I saw dense forests ablaze with fall color. Houses with precariously steep driveways clinging to hillsides. Trailer homes parked end to end on a narrow strip of flatland along the riverbank.

However beautiful the landscape, this can be a deadly place. The narrow spits between the river and the rock face act as ­funnels, creating catastrophic floods. In 1977, a community upstream of Grundy got 16 inches of rain in a single day. The Levisa sent 6 feet of water rushing through town, leaving three people dead and inundating Main Street.

After the flood, town elders came up with a radical plan. With nearly $200 million from the US Army Corps of Engineers and the state, Grundy packed up and moved to higher ground. Main Street was mostly demolished and floodwalls were installed. The engineers even blew up a mountain, carting away 2.3 million cubic yards of rubble, to create a 13-acre plateau, home to what is now arguably Grundy’s beating heart: a three-story Walmart that opened in 2011. “Grundy may be one of the only towns in the United States,” Grundy native Lee Smith wrote in her memoir, Dimestore, “that has ever actually invited Walmart into its downtown area, instead of organizing against it.”

The project mitigated some of the flood risk but didn’t eliminate it. One day in February 2025, Buchanan County was deluged with 7 inches of rain. Flash flooding killed a person in neighboring Bland County. Mudslides washed out roads, destroyed 17 homes, and left hundreds more damaged—others were left without power and clean water. The sheriff’s office reported that 280 people were rescued. It was the fifth major flooding event since 2021.

The law school, too, was inundated. Scores of students lost most or all of their possessions. Dean Western recalls he personally “lost everything” in his basement.

Glenn Youngkin, Virginia’s Republican governor, asked the Trump administration for an expedited major disaster declaration that would enable locals and the state to seek federal assistance. Such declarations are at a president’s sole discretion. When Hurricane Helene came through in 2024, President Joe Biden approved an emergency declaration three days after the storm first made landfall in Florida. But Trump sat on Youngkin’s request for nearly two months. Even then, the administration did not approve assistance for individuals.

Last April, Sen. Mark Warner (D-Va.) held a town hall meeting in Grundy ­focused on flood recovery. “I’m just more confused because I thought we were going to get some individual help and as of right now, I don’t know that we are,” local resident Patricia Cooper told him. Warner replied that he, too, was frustrated.

“A lot of businesses have not recovered,” notes Garrett Jackson, public affairs director for People Inc., a nonprofit that provides affordable housing and a host of critical services in Buchanan County. Many areas are still “just devastated,” he says. “This area did not get a lot of the FEMA attention that it should have.”

The Federal Emergency Management Agency is charged with coordinating every facet of disaster response, from search and recovery to housing assistance to debris removal—services county residents desperately need now that climate change has exacerbated their flooding problem. But Trump is determined to dismantle FEMA, which he says is “very bureaucratic and it’s very slow.” As Grundy was getting swamped, Elon Musk’s Department of Government Efficiency was busy carving a trail of destruction through the agency, where about 2,000 workers were laid off or bought out by last summer. FEMA didn’t have a permanent director between Inauguration Day and December, when Trump appointed an election conspiracy theorist with no disaster management experience to run its Office of Response and Recovery. In early January, the Washington Post reported that the Department of Homeland Security was planning further cuts that could reduce FEMA’s disaster response workforce by thousands more.

At Warner’s town hall, Grundy officials said they needed help paying for projects to mitigate future flooding. The Biden administration had aimed to do just that via the Inflation Reduction Act. Five days before Trump took office, Sen. Warner and fellow Virginia Democrat Sen. Tim Kaine announced that the Environmental Protection Agency had awarded the University of Virginia nearly $20 million to fund climate resilience projects in Southwest Virginia. About $5 million was slated for Buchanan County to build housing outside the flood plain. But EPA Administrator Lee Zeldin canceled the grant. “The objectives of the award are no longer consistent with EPA funding priorities,” the termination letter read.

It’s “the perfect example of where the Biden administration did something for a very rural Appalachian area, but it wasn’t pushed by the press in this area,” says ­Jackson of People Inc. “People don’t see truly who’s trying to help them.”

In the school parking lot, I strike up a conversation with number 82 in line, who is leaning against a car chatting with friends through the window. She declines to reveal her name but says she lives in Grundy and works for the state. She’d arrived at 5:30 a.m. for a filling. In 2024, she had two teeth pulled. “I’ve got insurance,” she assures me, “but the co-pays are ridiculous.” In 2014, she says, a RAM dentist had pulled all her husband’s teeth. During Covid, she’d come in for free eyeglasses.

Her father was a coal miner and she supports Trump, she says, because Democrats are too “focused on the environment.” She is also unhappy about “how we’re giving money to the wrong people.”

“I would love to see jobs come back to this country,” she says. “I want to buy American.”

Nikki Hardin, the car’s driver, is number 54, having arrived here at 3:30 a.m. with her cousin. I ask them if they follow politics. “Only when I vote for Trump!” Hardin volunteers, prompting laughter from her companions. They’d all voted for him. Hardin informs me that the president “is a very successful businessman” who is “helping the poor people.”

We chat about life in Buchanan County, and the women bemoan the dearth of local amenities and entertainment options. They insist, like most everyone I spoke with, that the only good sit-down restaurant in town is Grundy’s Mexican joint, El Sombrero.

Too tired to venture out that night, I opt for the Italian place next to the town’s single hotel. The restaurant walls are decorated with big posters of the region’s high school sports mascots, including the ­Hurley Rebels with their Confederate flag. Near the register is a framed USA Today clipping about that school’s fealty to its racist symbol; its front doors create a giant flag.

The next day, for lunch, I try El Sombrero, which is in a little mall attached to the Walmart. Pickup trucks with “Don’t Tread on Me” plates are parked outside. Inside, it feels like a little slice of Jalisco—the state in western Mexico famous for ­tequilas and mariachi music. The spacious restaurant has a full bar and a big menu. High-backed chairs are brightly painted with Mexican pueblo scenes. A card commemorating Saint Toribio—a Jalisco priest executed for defying anti-clerical laws in the 1920s—hangs near the register.

I order carnitas served on cheerful fiesta ware and watch as the place fills up, almost entirely with white people coming from church. My server is quick and friendly and speaks very little English. With my rudimentary Spanish, I gather that he is from Mexico, like El Sombrero’s owners. Until today, I’d seen almost no immigrants in the county other than RAM volunteers. El Sombrero is the go-to destination for kids going to prom or college students looking for a night out. I wondered how it could survive in a place where people had voted overwhelmingly for a president they hoped would ship out all the immigrants.

I later learned that Buchanan County Sheriff Allen Boyd, a regular customer, ate dinner here about two weeks before my visit, and then assisted ICE in setting up a late-night checkpoint that nabbed two El Sombrero employees. One was known as Little Lupe. The other was Alejandro Martinez, a waiter who’d been a fixture in Grundy for more than 15 years. Lupe was released, but Martinez was quickly deported to Mexico.

The deportation sparked a flurry of ­social media posts expressing shock that a law-abiding waiter would be taken by an administration that claimed it would only target “the worst of the worst.” “Mr. Allen Boyd and his masked thugs waited for them to leave and head home,” the owner’s daughter-in-law wrote on Facebook. “That’s when they were pulled over, pulled them out of the vehicle and shoved them to ICE…Our men do not deserve this in any way, shape or form.”

One Facebook poster wrote, “They can get the one illegal immigrant in Buchanan County, but the 4000 meth-heads are fine. ok.” Another chimed in: “Did I vote for TRUMP??? YES, I DID but that didn’t mean my friend had to be done this way.”

Martinez himself was a Trump supporter, as were the restaurant’s owners. “I’m pretty sure they had a Trump flag in there at one time,” a person close to ­Martinez told me, adding that locals had convinced Martinez and the owners that “if Trump didn’t get into office, coal would die, and the town would die.”

After news of the deportation spread, residents speculated that ICE was paying off snitches and worried that El Sombrero would close because of ongoing ICE harassment. Because of the uproar and furious rumors, Boyd was forced to issue a statement acknowledging that money was a factor in the immigration operation. He’d signed a lucrative agreement to cooperate with an ICE task force that netted his department $100,000 for vehicles, $15,000 for equipment, and more money for the salaries of cops who worked the task force.

Boyd referred all requests for comment to an ICE spokesperson, who never answered any of my questions. He seemed to concede in his press release that the county had bigger problems than a few Mexican waiters, but “when a federal agency requests assistance from our Sheriff’s Office to help enforce federal law, we have a duty—under the oath we swore—to respond and support that effort.”

“Narcan training starts in 5 minutes!” This announcement blares over the school loudspeaker as I walk down a hall lined with tables hosted by social service agencies on hand to assist RAM patients. At one table sits ­Celeste Barrett, who oversees eligibility for federal safety net programs in Buchanan County, including food stamps. She’s been doing this about 25 years and knows the county’s demographics intimately.

Of its roughly 19,000 county residents, she informs me, about 11,000 get some form of federal aid, including Medicaid, Temporary Assistance for Needy Families, and energy assistance. About a quarter receive SNAP benefits. This helps explain why Trump’s second term could exact such a huge local toll.

Trump’s big budget bill includes the biggest cut to SNAP in the program’s history, about $187 billion over 10 years, which translates to a direct loss of about $2.3 million a year in Buchanan County, according to the nonprofit Voices for Virginia’s Children. The legislation requires recipients to work 80 hours a month and creates new burdensome recertification requirements. The state already had a SNAP work requirement, Barrett told me, but given the high rate of local unemployment, Buchanan County was always exempt. That exemption is over. After six months, Barrett notes, if an applicant fails to satisfy the work requirement—and correctly submit all of the required paperwork—“they will be disqualified for 30 months.”

The bill also killed exceptions for veterans, unhoused people, and youth in foster care. Under the old law, people with children under 18 were exempt, too, but Trump’s bill lowered the age limit to 14. Voices for Virginia’s Children estimates that about a third of the county’s households will lose some or all of their benefits. “I don’t know how you prepare for something like that,” Barrett says.

Buchanan County has four food banks, but their services are strictly limited. I happened to be visiting the one day per month when one of them, Feeding My Sheep, was distributing food, so I decided to check it out. Located about 10 miles from Grundy, Feeding My Sheep works out of a nondescript blue warehouse on a narrow slip of land between the road and a sheer rock cliff that leaves almost no room for parking. Getting there involves a harrowing drive on a steep, winding road through sparsely populated mountains. I nearly miss the food bank coming around a turn.

Inside, I find a handful of elderly volunteers who direct me to Reva Fields. A deeply religious woman with a no-nonsense ­manner,­ Fields took over the operation in 2013 with help from her husband, Jerry, who used to work in the mines. Now his knees are shot, and he has a pinched nerve in his back, so he needs a walker to get around.

With a budget of about $65,000 a year, which comes from county and coal company foundation grants, and food donations from Walmart and Food City, Feeding My Sheep distributes staples to roughly 500 families. People line up early at a parking lot on the Southern Gap, a flat, 3,000-acre expanse created when the mountaintop was strip-mined.

Fields shows me around a warehouse with pallets of canned corn and other sundries stacked to the ceilings. A walk-in refrigerator holds fresh produce from ­Appalachian Harvest, a nonprofit rural food hub. In March 2025, the US Department of Agriculture paused $500 million in food bank–related programs and whacked $1 billion from a program that lets schools and food banks buy directly from local farms. “We are getting less food from USDA,” Fields says. She consults a notebook.

In the first three quarters of 2024, Feeding My Sheep received about 414,760 pounds of food. For the same period in 2025, it got roughly 65,000 pounds less—a 16 percent shortfall­—which could have fed about 1,000 families, she notes. Appalachian Harvest used to provide more fresh food from farms, Fields says, but that’s declined, too. (Sylvia Crum, development director for a group called Appalachian Sustainable Development, later told me that Trump’s clawback of USDA grants cost her organization $1.5 million for its program purchasing food from local farmers to donate to food banks like Feeding My Sheep.)

As Fields and I chat, a gaunt older man wearing a faded Han Solo T-shirt pulls up to the warehouse on a bike. He dismounts and walks unsteadily up the ramp to the office using a small, upside-down garden hoe as a cane.

Fields fetches an old cane she had in the office. He accepts this gift, along with a box of food the volunteers packed just for him: jars of peanut butter and pickles, hot dog buns, canned corn, cheddar puffs, cereal, and raisin packets. A woman brings him some Gatorade. He inspects a box of Devil Dogs snack cakes and tries to figure out how to make it fit in his backpack.

Given the steep, twisty roads, I’m impressed he made it here on a bike. He used to ride everywhere, he says, until he got hit by a car in 2024. He was paralyzed from the waist down for a while until he was able to have back surgery. Eying his overflowing pack skeptically, Fields asks if her husband can drive him home. “If it ain’t too much trouble,” the man says quietly. They throw his bike in the back of a truck and the two drive away.

One of the volunteers mentions that SNAP benefits were due to be cut on ­November 1 because of the government shutdown. “That’s going to be terrible,” Fields says with alarm. “If they cut out food stamps, we’re going to be swamped. In this area, they’ve already laid off a bunch of people from Wellmore. They need help.”

The prediction proved prescient. In a Facebook post at the end of November, a month after the new SNAP rules took effect, Feeding My Sheep announced, “Our shelves are currently depleted. We typically maintain a three-month supply of food. This past month, we distributed 32 percent more food than usual. Notably, we served a record 630 families.”

Did Fields know that Trump’s budget cuts were the reason she was getting less food from USDA, and why SNAP was getting cut? Her response reflected the restraint I had come to recognize in the women here, especially when dealing with outsiders. “He may not realize what’s happening,” she ­finally responds. “I’m praying that he will take care of America. I’m hoping he gets food to the needy.”

After making my way back to Grundy, I stop in at St. Joseph’s Catholic Church for Mass. The modest brick church is perched high on a ledge of stone carved out of a mountain. The small parking lot is unfenced, and I have a little panic attack as I realize how easy it would be to accidentally drive off the cliff.

With only 15 or so members, the church relies on a traveling priest from the Philippines who conducts Saturday afternoon Mass in Grundy before visiting other parishes. A Nigerian student from the local pharmacy school assists with communion. As we pray for the RAM volunteers and patients, I think about how, despite the myriad ways Trump’s policies will harm locals, very few of the people I’ve met seem to hold him responsible. Nor can they articulate why they are standing by him. No one has mentioned abortion—or even inflation. They tend to fall back on immigration as Trump’s signature selling point. ­Hurley’s theory is that “people want to believe the best of him because they’ve been with him for so long,” and alternate viewpoints are in short supply, because “the only people they’re hearing from are Republicans.” Hurley has served as Democratic Party vice chair in neighboring Russell County, where her chapter lacks enough active ­participants even to give out hot dogs on July 4. “It’s me and another guy against 1,000 angry [Republicans],” she says.

A handful of locals have admitted to her they regret voting for Trump, she says, but that’s only translated so far into seven new members for her group. “It’s a hive mindset,” she says. Sure, the people here ­overwhelmingly support Trump, but “when they were Dems, they were 80 percent Dems. There was never a split.”

On Sunday morning, I find Frannie Minton, a force of nature with a pixie haircut who is almost single-handedly responsible for bringing RAM to Grundy. From her command center in the middle school’s main office, she answers phones, makes loudspeaker announcements, dispatches runners, and fields all manner of requests. She refers a woman who needs a wheelchair ramp for her house and maybe hearing aids to a group that will help with both. She dispenses mammogram referrals and advises a student volunteer on medical school applications.

A nurse for 45 years whose father was the town doctor for decades, Minton knows everyone in Grundy. She also runs the local chapter of Daughters of the American Revolution, which makes sandwiches for patients at the dental clinic. She’s active in the town’s tiny Catholic church—she’d like Pope Leo to make RAM founder Stan Brock a saint. And somehow, she still finds time to run a primary care clinic out of the local Food City.

Minton brought RAM to town in the early 2000s, after witnessing its work in Kentucky. “It’s an honor to be here,” she tells me. “Everybody is helping their fellow people. It’s like the beatitudes. It’s my warm fuzzy.” She’s well aware of the county’s dire health care situation, but says she’s seen some improvements. A 2018 report noted that for the entirety of 2015 and 2016, nearly 40 percent of adults under 138 percent of the poverty line were uninsured. A year later, the state finally expanded ­Medicaid through the Affordable Care Act, and by 2023, that figure had fallen to just over 12 percent of county residents.

With more people insured, demand for RAM’s services has ebbed. In 2017, the clinic saw 744 patients in a single weekend. The weekend I visited, there were 313, who came mostly for free glasses and dental work. But Trump’s Big Beautiful Bill may reverse those figures. Buchanan County is slated to lose more than $40 million in Medicaid funding by 2034. More than 22,000 people in Virginia’s 9th Congressional District, which includes Buchanan County, are ­expected to lose coverage, as are nearly 15,000 more who get their insurance through the Affordable Care Act.

These cuts imperil the county’s lone hospital and other, bigger ones in Southwest Virginia. Because Medicaid and Medicare payments don’t cover the true cost of care, private payers must make up the difference. In Buchanan and other poor rural counties, nearly 75 percent of hospital patients have Medicaid or Medicare, explains Julian Walker, VP of communications at the Virginia Hospital & Healthcare Association. This leaves many rural hospitals in the red. Last summer, a group of Democratic senators released a list of rural hospitals at risk of closing because of Trump’s bill—two are here in the 9th District.

Drug treatment facilities that rely on Medicaid are also endangered in Buchanan County, where opioid overdose deaths and ER visits are vastly higher than in the rest of the nation. “I am worried about our local hospital,” Minton says. “I’m worried about health care in general. The people are so poor.” She voted for Trump in 2016, believing the country “needed a clean sweep.” But “this wasn’t a real broom.”

I think about the conversation I had after Mass with Doug Vance, a parishioner wearing an American flag lanyard and using a walker. Vance is a former teacher of students with disabilities in Grundy schools who lives over the border in West Virginia. He also volunteers at the RAM clinic. He told me Appalachia is inhabited by “cracks people”—as in people who fall through them. He pointed to the three people killed in his county during the February 2025 floods. They barely made the news.

I sensed he might be a Democrat. And like many from around here, he says he was—once. But when I asked him about the funding Trump has rescinded from social programs and how that might hurt his neighbors, he replied angrily, “Some of it needs to be rescinded.” The deficit needs reining in, he argued, and plenty of people were getting benefits they didn’t really need.

That’s a sentiment often expressed by another Vance, far more famous, to whom Doug thinks he may be distantly related.

Trump is “doing great!” this Vance ­insisted. He loved that the deal-making president got donors to pay for a new White House ballroom rather than making taxpayers foot the bill. “What has been happening in Israel has been tremendous,” he added. After listening to him tick off Trump’s accomplishments, I finally asked him about the president’s core economic policy: the tariffs.

“I’ve been affected by it,” Vance admitted after a long pause. He has a Subaru that was damaged and needed repairs. The first quote was $3,000. But by the time he went to get the work done, the price had doubled because of tariffs on auto parts. “That’s the price you have to pay,” he lamented.

“For what?” I replied with bewilderment.

Inflation in auto parts, he informed me, was a necessary trade-off for the strong economy that was surely coming. “Sometimes,” he said, “we have to sacrifice.”