I haven't read the whole thread, only tuning in for the last several comments.
I live near Schuyler, Va. (The location of the real Walton/Earl Hammer house) and work on patients there, in the valley and in West Va. With the exception of meth issues, I find the people here great. I live in Nelson, so these are my neighbors as well.
In College, my girlfriend grew up off the Blue Ridge parkway in SW Va. South of Roanoke. She grew up in a cabin her grandfather built, no electricity, and took a shower out of bucket of cold mountain stream water poured at will over her head by pulling on a rope to tip the bucket in an outdoor semi enclosed stall. Imagine that in winter.
In grade school, she caught the kitchen on fire, but they were able to put it out, so the cabin wasn't completely lost, but with no insurance, they still had to live in the charred kitchen. Her father drove a school bus and with funds from logging their land, were able to build a modest house further up the hill. Point being, amazing family, but, they had land which helped out. They didn't use public assistance. His car was an aging pinto. Did it matter one bit? No. They were/are a happy family.
Most of the folk I know are doing just fine, and, really, it boils down to attitude. Many don't want the handouts, and are just great as is. As public assistance has increased in our state, so has a squalor of freeloaders, who are not Appalachian Folk at all. There is a huge difference between the two. No comparison.
As for the original title "Being poor is expensive"- I'll enter an example of something I noticed as of late. My favorite American made dress shoe "Allen Edmonds" had a summer sale- It's actually going on now. At $395- $425, the shoe is expensive, but rebuildable. On sale, it is $245, and this weekend is 30% off that- so now about $175. Some models more, some even less. That's a huge discount for American made quality shoes. Now compare that to a cheap dress shoe, say Kohls or something for $120 bucks. It has a sole of pressed cardboard. It is crap. Buy the $120 dollar shoe and get a year or two tops out of it. An AE shoe can give twice the wear easy, and be rebuilt for $125, getting one back up to a $400 shoe.
But here's the best part, since the shoe is so in demand, people will buy used AE shoes on ebay for $100+ dollars easy, so, basically, I can get a pair of $425 shoes for $175 (if I time it right), sell them a year or two later for $100, so my cost of ownership is $75 dollars for a really good American made shoe versus the cheap Kohl's made in some other country shoe at $125.
The example- being so strapped for cash one cannot step up to the better shoe- actually is more expensive in the long run.
There really are items where being able to step up a bit can save money, even if not on sale. Also, this is said with full humble knowledge not everyone can just go plopping down $100's on nice shoes. For that I am grateful. Just a fwiw.