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Woman barkeeper perhaps daydreaming of places far removed from where she works, West Virginia, 1978. At one point, more than 100,000 West Virginians worked in the mines that produced well-paying jobs. Now there are fewer than 20,000, and the jobs that do exist pay far less than they used to, thanks to successful anti-union actions by coal companies. Coal counties in Appalachia suffer high rates of heart disease, obesity, smoking, diabetes, and opioid abuse, leading them to have some of the lowest life expectancies in the country. Jon Chase photo