“We’re losing our best and brightest,” Roger Ford, the 58-year-old president of an energy startup, told me sadly one day as we ambled through a hillside cemetery brightened by graveside flowers. “Too many young people are leaving these mountains looking for jobs in cities, and too many of the ones who stay behind have been caught in an opioid epidemic.”

Mr. Ford has lived here in Kentucky’s Pike County all his life. Around us lay the graves of his ancestors, proud locals all. His great-grandfathers on both sides fought in the Civil War, and uncles and cousins fought in World War I and II.

As the native-born leave the mountains, few immigrants venture in. So as Mr. Ford and I entered a small, empty church nearby, a question seemed to hang in the air: In years to come, who will run the region’s restaurants, gas stations and start-ups, plow its gardens, and honor its dead?

On the Greasy Creek Elementary School Facebook page, Mr. Ford describes himself as “Kentuckian by birth, Southern by the grace of God, Freemason and Shriner.” He is pro-life, pro-gun, pro-police, pro-wall and anti-tax, and told me “God sent Donald Trump.” And many thought God had.

In the 2024 election, 81 percent of Kentucky’s Fifth Congressional District — the whitest and third poorest in the nation — voted with Mr. Ford for Donald Trump. Once full of New Deal Democrats, the region had suffered losses that its people felt modern Democrats didn’t care about or address. During World War I and II, the “black gold” dug out of their mountains fed industrial America. Then the coal mines closed, and the drug crisis crept in.

In 2016, Mr. Trump’s answer to these losses took the form of policy promises and a story. Many of the policies he promised never panned out. As James Browning, a thoughtful drug counselor and grandson of a coal miner killed in a mining accident, recalled, he never brought back coal or “great, new jobs.” He did “nothing about drugs.”