Joblessness in the United States recently hit its lowest point since the 1960s; the Dow Jones Industrial Average reached an all-time high last year; and America is now home to at least twice as many billionaires as any other country.

In this context, it can be easy to overlook the parts of the country that have been left behind. In dozens of communities across the United States there is widespread poverty and failing local businesses. In these areas, the population is shrinking and the average life expectancy at birth more closely resembles that of countries like Indonesia and Egypt.

24/7 Wall St. constructed an index of three measures — poverty, the percentage of adults who have at least a bachelor’s degree, and average life expectancy at birth — to identify the worst counties to live in. Many of these counties also rank among the poorest and least healthy counties nationwide.

Nearly every county on this list falls into one of three categories: counties in Appalachian coal country, Southern counties along or near the Mississippi River, and those that lie within Native American reservations. Though these types of counties have very different histories and geographies, they each paint a similarly bleak picture of the underbelly of the largest economy in the world. To determine the 25 worst counties to live, 24/7 Wall St. constructed an index consisting of three measures: bachelor’s degree attainment rate, poverty rate, and average life expectancy at birth. Data on life expectancy is from the Institute for Health Metrics and Evaluation — an independent population health research center at the University of Washington. All other data is from the U.S. Census Bureau’s 2017 American Community Survey and are 5-Year estimates.

Click here to see the worst counties to live in.