Feb. 10, 2009 -- In the hills of Central Appalachia, up winding, mountain roads, is a place where children and families face unthinkable conditions, living without what most Americans take for granted.
Isolated pockets in Central Appalachia have three times the national poverty rate, an epidemic of prescription drug abuse, the shortest life span in the nation, toothlessness, cancer and chronic depression.
It's been 41 years since Robert Kennedy called on the rest of America to reach out and help the people of Appalachia. These are the descendents of Davey Crockett, Daniel Boone, Loretta Lynn and Patsy Cline and the families of legendary soldiers and pioneers who helped open up the treacherous mountain passes and create an American continent. They are fighters steeped in family, ferocity and faith.
For nearly two years, ABC News cameras followed four Appalachian children, each one facing unimaginable obstacles.
Shawn Grim, 18, an Appalachian high school football superstar, sleeps in his truck to avoid the thievery, alcoholism and despair of his family's life in the hollow in Flat Gap, Ky. During the course of Sawyer's report, Grim moves eight times. He is determined to be the first one in his family to graduate from high school and go to college. Will he be able to achieve his dream of a different life?
Courtney, 12, is one of those children whose face reminds us of the famous portraits of the Appalachian past. Her clothes are stuffed in a suitcase under her bed in the small home she shares with 11 relatives in Inez, Ky. Her mother, Angel, struggles to stay off drugs and hopes to give her four daughters a better life by getting her GED and becoming a teacher. With no car and no public transportation, Angel walks 16 miles roundtrip, four hours total, to her GED class.
Erica, 11, hopes to save her mother's life: "She's almost 50 and… if I don't get her out of this town soon, then she'll probably die any day." Erica and her mother, Mona, live in Cumberland, Ky., a once booming coal town. Mona battles addiction to prescription drugs and alcohol, her life ravaged by her struggles and despair. The region has a prescription drug abuse rate twice that of major cities like New York or Miami.
When his girlfriend becomes pregnant, Jeremy, 18, trades his dream of a life as an engineer in the military for a life underground in the coal mines. Sawyer travels down 3½ miles to the dangerous working face of the mine to meet Jeremy and the other men who work nine to 12 hours a day, six days a week, with little sunshine in their daily lives. But despite the safety concerns, it is the best paying job in the region.
There are also heroes in the hills -- teachers, social workers, doctors and dentists reaching out to a population isolated by the steep hills and lack of transportation.
Nicknamed the Mother Teresa of Mud Creek, Eula Hall, 81, has spent 36 years transporting the sick out of the hills and into her clinic. Working with her is Dr. Anant Chandel, born and raised in India.
"It's hard to believe but yes… people are poorer in this part of the country than where I was in India," he said.
Another hero of the mountains is Dr. Edwin Smith of Barbourville, Ky. He used $150,000 of his own money to convert a truck into a mobile dental office. Dentists say Central Appalachia is first in the country for toothlessness. One of out 10 residents is completely without teeth and children as young as 2 already have as many as 12 cavities.
"A Hidden America: Children of the Mountains" is a continuation of Diane Sawyer's reporting on America's forgotten children. Sawyer won an Emmy for outstanding feature story in a news magazine for "Waiting on the World to Change," a firsthand account of poverty among children in America, which aired in 2007. The yearlong reporting followed the lives of children in one of the poorest cities in America who struggle daily to succeed despite horrendous odds.