Chaos. Frustration. Compassion. Desperation. Hope. These are the five words that author Wendy Welch says best summarize the state of foster care in the coalfields of Appalachia. Her assessment is based on interviews with more than sixty social workers, parents, and children who have gone through “the system.” The riveting stories in Fall or Fly tell what foster care is like, from the inside out.

In depictions of foster care and adoption, stories tend to cluster at the dark or light ends of the spectrum, rather than telling the day-to-day successes and failures of families working to create themselves. Who raises other people’s children? Why? What’s money got to do with it when the love on offer feels so real? And how does the particular setting of Appalachia—itself so frequently oversimplified or stereotyped—influence the way these questions play out?

In Fall or Fly, Welch invites people bound by a code of silence to open up and to share their experiences. Less inspiration than a call to caring awareness, this pioneering work of storytelling journalism explores how love, compassion, money, and fear intermingle in what can only be described as a marketplace for our nation’s greatest asset.

The firsthand pandemic experiences of rural health-care providers—who were already burdened when COVID-19 hit—raise questions about the future of public health and health-care delivery. This volume comprises the COVID-19 pandemic experiences of Appalachian health-care workers, including frontline providers, administrators, and educators. The combined narrative reveals how governmental and corporate policies exacerbated the region’s injustices, stymied response efforts, and increased the death toll. Beginning with an overview of the SARS-CoV-2 virus and its impact on the body, the essays in the book’s first section provide background material and contextualize the subsequent explosion of telemedicine, the pandemic’s impact on medical education, and its relationship to systemic racism and related disparities in mental health treatment. Next, first-person narratives from diverse perspectives recount the pandemic’s layered stresses, including the scramble for ventilators, masks, and other personal protective equipment the neighbors, friends, and family members who flouted public-health mandates, convinced that COVID-19 was a hoax the added burden the virus leveled on patients whose health was already compromised by cancer, diabetes, or addiction the acute ways the pandemic’s arrival exacerbated interpersonal and systemic racism that Black and other health-care workers of color bear not only the battle against the virus but also the growing suspicion and even physical abuse from patients convinced that doctors and nurses were trying to kill them These visceral, personal experiences of how Appalachian health-care workers responded to the pandemic amid the nation’s deeply polarized political discourse will shape the historical record of this “unprecedented time” and provide a glimpse into the future of rural medicine. Contributors: Lucas Aidukaitis, Clay Anderson, Tammy Bannister, Alli Delp, Lynn Elliott, Monika Holbein, Laura Hungerford, Nikki King, Brittany Landore, Jeffrey J. LeBoeuf, Sojourner Nightingale, Beth O’Connor, Rakesh Patel, Mildred E. Perreault, Melanie B. Richards, Tara Smith, Kathy Osborne Still, Darla Timbo, Kathy Hsu Wibberly