It is difficult to imagine such levels of poverty existing in the most powerful nation on earth - but it does in McDowell County, West Virginia.
Abandoned shops, closed schools and neglected homes are visible on almost every corner in every distressed community.
Whole families are plagued by the consequences of unemployment and widespread drug abuse.
The average life expectancy for men is 64 - the same as Namibia.
But it was not always like this. McDowell was once a hustling and bustling town, thriving off the riches of the coal industry.
The reliance on one industry proved fatal and boom soon turned to bust.
The collapse of coal and thousands of jobs has left the county a crumbling shell of its former self.
A mass exodus of people has seen its population dramatically fall from over 100,000 in the 1950s to a little over 20,000 today.
Those that have stayed wonder when - or if - any glimmer of hope and prosperity is going to emerge.
Matt McPeak, a former miner turned heroin addict who lives in the town of Welch, says his community has been forgotten and left behind to live "like dogs".
"There are no jobs and nothing but drugs," he told ITV News.
"They're [his friends] dying - I buried one the other day. It's overdose after overdose."
Attempts to diversify the local economy have failed.
A nearby federal prison employs 305 people but only 41 members of the workforce come from Welch.
Locals who do seek work at the prison fall at the first hurdle - by failing a mandatory drugs test.
Many jobless residents feel they have no choice but to turn to crime or risk their lives to provide food for their children.
Clay Epperly went inside an abandoned mine on Monday to search for scrap metal to sell.
But he did not come out, leaving his two young daughters, Mya and Serenity, without a father.
His grieving mother told ITV News her son is a victim of the dire economic situation that has become entrenched in the county.
People believe life could become even worse if Hillary Clinton is elected president on November 8.
The Democratic candidate is viewed as the enemy in this region.
It comes after she pledged in March to "put a lot of coal miners and coal companies out of business" in favour of renewable energy industries and tackling climate change - a declaration of "war" in the eyes of many.
Jimmy Poore, a coal truck driver for over 25 years and registered Democrat, said: "If Hillary Clinton gets president, my way of life is over."
The animosity felt towards Mrs Clinton has allowed her rival Donald Trump to cement his support in the region, with many buying into the billionaire's narrative that he is the person to restore McDowell to its former glories.
"He has a track record of being able to create jobs, business and we'd like to give him the chance to do that," said Gordon Lambert, an ex-NFL player who returned to his birthplace to become county commissioner.
Matt McPeak said: "I've got faith in Donald. He's an entrepreneur, he's got all his money and I don't see why he don't let us do what we know best and that's digging."
He added: "I want a piece of the pie - I don't want to lick the plate. We don't ask much."