Today, there have been improvements in the region and many communities are flourishing. Highways now link the mountain towns to cities in the valley, and reduce what used to be day-long trips to a matter of hours. One-room schoolhouses have been replaced by fully-equipped buildings, all of which has helped pull up national achievment rankings. But roughly 40 percent of Appalachia's population in the hills and hollows remains stuck in poverty, still searching for the road to success.
At the start of his senior year, Grim led the state of Kentucky in touchdowns. The star of his high school football team, the Johnson Central Golden Eagles, hoped to use his football prowess to win a scholarship to college.
Grim's family lives in a hollow in Flat Gap, Ky., where thievery and alcoholism are rampant. He was so eager to break away that he moved out of the family's trailer.
"The whole entire hollow is nothing but family, and all of them hate each other, so it's all fighting," he said.
He wanted to be the first in his family to graduate from high school.
"I want to go out here and I want to make everybody proud of me," he said. "And I want to make everybody happy that I'm actually trying something and doing something with my life, and I don't want to mess up."
Over the two years that ABC News spent with Grim, he moved at least eight times. He stayed with assorted friends and relatives and sometimes even slept in his beat-up red truck.
In the trailer in Flat Gap, Grim's mother Tina proudly pointed out the cabinet filled with her son's trophies and showed off scrapbooks of his successes to visitors.
"I want him to have something to pass down to his kids when he does have them," she said.
She also took out the family prescription pills that she locks away with her prized coin collection. If she tried to sell them, she said, these doctor-prescribed pills for nerve and back pain could go for $120 per bottle.
"I lock up all my pain medication and my nerve pills, so that way I don't got to worry anybody else stealing 'em off me," she said.
Grim's football coach and mentor, Jim Matney, does what he can to help Grim succeed. Matney was born in the mountains and traded his high school wrestling skills for a college scholarship. He returned to his hometown and has been coaching for 27 years.
"We want him to be able to trade his gift for football to have a better life," he said.
In another part of the hills, 11-year-old Erica prayed for her mother, Mona, to beat her addiction to painkillers.
"She's almost 50, and if I don't get her out of this town soon, then she'll probably die any day. The future, we'll never know about," Erica said.
Mother and daughter live in the abandoned coal town of Cumberland, Ky., but Erica dreams of moving them to Georgia where a friend lives.
When ABC News first met Erica, Mona was being sent to rehab, but she soon returned home to her daughter and her addiction. To escape, Erica goes on walks through the boarded-up town. She says she knows when her mother is high by the look in her mother's eyes.
"The reason I go on these walks is because I want to get away from my mom when she's like that," she said.
Erica has a guardian angel, a mentor named Karen Engle, the executive director of Operation UNITE.
"She's a very special young lady and has a lot of potential, but she's got a lot of obstacles like a lot of our kids do," Engle said.