Feb. 13, 2009 -- The oldest mountains in America are rich in natural beauty with their raging creeks, steep hollows and old pines. They are also one of the poorest, most disadvantaged regions in America.
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Central Appalachia has up to three times the national poverty rate, an epidemic of prescription drug abuse, the shortest life span in the nation, toothlessness, cancer and chronic depression. But everywhere in these hills, there are also young fighters filled with courage and hope.
Settled by tough pioneers who clawed their way over the Appalachian Mountains to expand America's borders, the region has produced some of the fiercest military fighters the country has seen. Like their ancestors before them, the children of the mountains are born fighters, and for two years, ABC News has documented the unique challenges some of these rural children face as they chase after their dreams.
Courtney, 12, hopes for a home for her and her family.
"We're not like other people, we can't afford food after food after food," she said.
Shawn Grim, 18, tries to fight his way out of his dysfunctional family in the mountains by becoming the high school football star of Appalachia, while sleeping in a truck.
Jeremy, 18, makes a decision to accept a life down inside the mines, and Erica, 11, is forced to grow up too quickly, trying over and over again to save her mother's life.
'Mountains Are Like Your Mother's Arms'
For generations, poets and musicians like Patsy Cline, Loretta Lynn and Dwight Yoakum have been inspired by the majestic beauty of the land that spreads across 13 states and has towns named "Lovely," "Beauty" and "Kingdom Come."
"I think the mountains are like your mother's arms around you. They're holding you in one place," said Whitesburg, Ky., resident Nell Fields.
Forty-one years ago, Robert F. Kennedy traveled to eastern Kentucky to bring attention to a part of the country that desperately needed help.
At that time, almost 60 percent of families in Appalachian Kentucky fell below the poverty level. The average per capita income for the region was only $841, more than a third lower than the national average.
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 One-room schoolhouses have been replaced by fully-equipped buildings, all of which has helped pull up national achievment rankings.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.
Shawn: 'I Don't Want to Mess Up'
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.
Erica: 'I Want to Get Away'
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.
Launched in 2003, UNITE is an anti-drug initiative that combines law enforcement, treatment and education. Engle works tirelessly, confronting the prescription pill epidemic and educating students about the dangers of using drugs.
The prescription drug abuse rate that Engle sees in the mountains is twice that of major cities like New York or Miami. Kentucky is second only to Utah in prescription drug abuse.
"Every single family in our region has been affected by this," Engle said. "They're somebody's child, somebody's brother or sister, mom or dad, and it's changed the face of our region."
Many of the dealers are users themselves, traveling to places like Detroit or Philadelphia to buy OxyContin in bulk. Paying roughly $40 a pill in the big cities, they return to Appalachia with up to 150,000 pills and mark them up to about $120 because the desire is so great, the profits enormous. Engle said she's seen big dealers make almost $400,000 per month.
More common, though, she says, are the doctors who prescribe the cheaper pills like Xanax or Lortabs. Medicaid will pay for such prescriptions, which users then sell for a $4 to $10 profit per pill.
People will do anything to support their habit: They climb telephone poles to steal copper wires, melt them down and take them to a metal recycler for cash. Police told ABC News it's not uncommon for copper pipes to be stolen right out of the walls of people's houses.
Erica's mother Mona is drinking again, but says she has not gone back to pills.
Courtney: 'We Do Not Have the Money'
Across the mountains in Inez, Ky., 12-year-old Courtney's mother, Angel, also struggled to stay away from prescription pills.
"I would have to have 10 pain pills just to get started, to not be sick," she said. "I would do 30 to 40 a day, easy. There were days I'd go to drug counseling, but as soon as I left, I'd sit in the parking lot and snort a pill."
Courtney said she used to lock herself in the bathroom and cry when her mom got high.
She and her three younger sisters bounced from place to place and are grateful they now have a place to sleep -- at her grandparents' house where their two uncles, one aunt, three sisters, and her mom's boyfriend, Bill, also live.
"Honestly, I'd love for me, my mom, Bill and us girls to have our own home," she said. "But we do not have the money to do that. Bill is wanting to get a job, but we can't because we ain't got a car to get him back and forth."
Angel, 30, was trying to get her life together for the sake of her girls, walking 8 miles -- 2 hours -- each way to her welfare-mandated GED classes. She said that if she can pass the test, she has a chance of getting off welfare and maybe even becoming a teacher. Angel is still sober today.
Angel's mother, Dinah, 49, is happy to have the family under one roof where she can keep an eye on all of them. Talking about her daughter's generation, lost in pills and hopelessness, she said, "This generation is a me generation. It's not lost. They took a U-turn."
She prays that Jesus will help her family and finds solace in the Homecoming Church, run by Pastor Elmer Harris. Ten miles outside of Inez, the church is home to a congregation of families of Calf Creek Hollow. It's not unusual for the daily offering here to be $1.85.
Pastor Elmer said he "prays for God to send someone to help them. Help the poor."
Jeremy on Working in the Mines: 'I Love It'
Dee Davis, president of the Center for Rural Strategies in Whitesburg, Ky., said America should pay attention to the conditions in Appalachia.
"When the banking industry melts down, it's like, 'Oh, no, we have a structural problem. We need to reinvest in those people.' But when the folks in Appalachia or the inner city are poor, it's their fault," Davis said. "It's a lot easier to blame people for their poverty than to figure out what's next."
Only one in 10 men in the region will get a college degree -- less than half the national average. For those who do not, the only employment options are Wal-Mart, fast food, the drug trade or the mines.
Sixteen percent of America's coal comes from the hills of Appalachia.
Diane Sawyer traveled down into a mine to meet some of the men who work there. The mine, owned by Booth Energy, has a reputation for safety and caring about the men below. The miners work 9- to 12-hour shifts, six days a week, in return for one of the best wages and benefits in the region -- a starting salary of $60,000 a year.
Jeremy Hackworth, 18, loved math and wanted to be an engineer in the military, but when his girlfriend got pregnant, he said the responsible thing to do was provide for his family. Even though he's following his father and grandfather, it's quite a decision when a young man decides to go down into the mines for life .
When asked how he was liking his first day on the job, he said, "I love it."
"When these men go down under this ground, they don't know if they're going to come back out," said his mother, Lydia Hackworth, tearing up. "There's not a day don't go by that I don't pray for my boys under the ground, but I know God's going to bring them back."
When asked why they don't just leave the isolating hills, mountain people will tell you that once Appalachia is in your blood, it's in your blood forever.
"I love the voices," said Davis. "Every person, every challenge seems to be remembered in some story, in some way to make people feel better about who they are. I think, in many ways, Appalachia is America written with intensity.
"I mean, there's no reason to think that somebody who comes from the mountains of Appalachia can't succeed," he said. "I think it's just changing the contours of our expectations, and maybe the geography of our heart."