5. McCreary County, Kentucky
> 5-yr. pop. change: -2.5%
> Poverty rate: 41.0%
> Bachelor’s degree attainment: 7.6%
> Life expectancy: 72.9 years
Like other nearby counties in southeastern Kentucky, McCreary County has been decimated by the decline of the coal industry. Throughout the 20th century, over two dozen coal mines that once employed thousands of local workers shut down. While mining operations have begun to sprout up again in recent years, McCreary is still struggling economically. The county has a higher than average unemployment rate, and 45% of area residents with jobs commute to work outside the county limits. One of the poorest counties in the United States, McCreary has a 41% poverty rate, and half of all area households earn less than $20,000 a year.
4. McDowell County, West Virginia
> 5-yr. pop. change: -10.3%
> Poverty rate: 34.9%
> Bachelor’s degree attainment: 4.9%
> Life expectancy: 70.3 years
McDowell County is the worst county to live in in West Virginia and the fourth worst nationwide. A coal county located in the southern part of the state, McDowell is characterized by population decline and poverty. Currently, the county is home to less than 20,000 people, down from nearly 100,000 in 1950. In the last five years alone, the county’s population shrunk by 10.3%. Of the remaining residents, more than a third live below the poverty line.
Opioid overdoses are lowering life expectancy in the United States, and McDowell County has been hit especially hard by the opioid epidemic. Between 2010 and 2014, life expectancy in the county fell slightly from 70.4 years to 70.3.
3. Holmes County, Mississippi
> 5-yr. pop. change: -4.9%
> Poverty rate: 46.5%
> Bachelor’s degree attainment: 10.7%
> Life expectancy: 71.0 years
Holmes County is one of several counties in the Mississippi Delta to rank on this list. The county’s 46.5% poverty rate is nearly the highest of any U.S. county and more than triple the 14.6% national poverty rate. Additionally, 29.2% of household in the country earn less than $10,000 a year, the largest share of any U.S. county.
The widespread financial hardship is partially attributable to a weak job market. As of the end of last year, 8.7% of county workers were unemployed, and among those who had a job, 44% commuted to work outside the county limits.
2. Todd County, South Dakota
> 5-yr. pop. change: 3.1%
> Poverty rate: 52.0%
> Bachelor’s degree attainment: 16.2%
> Life expectancy: 68.5 years
Todd County is located along South Dakota’s southern border and includes much of the Rosebud Indian Reservation. Native American Reservations often have deeply entrenched economic problems, and Todd County’s 52% poverty rate is the highest of any county in the United States.
Todd County also has one of the least healthy populations in the country. Life expectancy at birth in the county is just 68.5 years — about 10 years less than the national average life expectancy.
1. Oglala Lakota County, South Dakota
> 5-yr. pop. change: N/A
> Poverty rate: 51.9%
> Bachelor’s degree attainment: 12.4%
> Life expectancy: 66.8 years
Oglala Lakota County, which falls entirely within the Pine Ridge Indian Reservation in southern South Dakota, is the worst county to live in in both the state and the country. Average life expectancy can be indicative of local conditions, and in Oglala Lakota County, life expectancy is just 66.8 years, the lowest of any U.S. county and more in line with life expectancy in developing nations like Pakistan and Tanzania than the United States.
Serious financial hardship is common in Oglala Lakota County. It is one of only two counties in the country where over half of the population lives in poverty, and nearly 55% of county residents rely on SNAP, or food stamps, to afford basic necessities.