20. Bennett County, South Dakota
> Poverty rate: 35.9%
> Adults with a bachelor’s degree: 15.7%
> Life expectancy at birth: 69.1 years
> Total population: 3,425
> Largest place in county: Martin
Bennett County lies within South Dakota’s Pine Ridge Reservation, an area struggling with several social, economic, and public health problems. For example, nearly 42% of adults in the county are obese, and by some estimates, one in every four babies born on the broader reservation have fetal alcohol syndrome. Life expectancy at birth in the county is just 69.1 years, a full decade below the national average.
For a variety of reasons, Americans with lower educational attainment often make less healthy lifestyle decisions, and those living below the poverty line often cannot afford adequate medical care or nutritious diets. In Bennett County, only 15.7% of adults have a bachelor’s degree and 35.9% of the population live below the poverty line, compared to the respective national rates of 32.1% and 13.4%.
19. Quitman County, Mississippi
> Poverty rate: 35.6%
> Adults with a bachelor’s degree: 10.3%
> Life expectancy at birth: 71.7 years
> Total population: 7,187
> Largest place in county: Marks
With one of the lowest life expectancies in the United States and one of the highest poverty rates, Quitman County, located in northwestern Mississippi, ranks among the worst U.S. counties to live in. The 35.6% local poverty rate is more than double the national poverty rate, and life expectancy at birth in the area is just 71.7 years, about seven years shorter than the national average.
Employment opportunities are relatively limited in the county. As of January 2021, 10.1% of the local labor force were unemployed, well above the comparable national unemployment rate of 6.8%.
18. McCreary County, Kentucky
> Poverty rate: 33.4%
> Adults with a bachelor’s degree: 7.2%
> Life expectancy at birth: 71.4 years
> Total population: 17,465
> Largest place in county: Pine Knot
McCreary County, Kentucky, is one of many in Appalachia with economic fortunes that are closely tied to the U.S. coal industry. Coal mining jobs once offered a living wage in the region without requiring a postsecondary education, and now, as U.S. energy production continues to shift away from coal, mining jobs in McCreary County have vanished. Throughout the early and mid-20th century, over two dozen coal mines in the county employed hundreds of local residents. Even as recently as 2012, the county produced nearly 32,000 tons of coal. Now, coal production has ground to a halt in the county.
About one in every three of the 17,500 people living in McCreary County live below the poverty line, and economic opportunities are limited for many in the area partly also because of the limited educational attainment in the county. Only 7.2% of area adults have a bachelor’s degree and 76.6% have a high school diploma, well below the respective national shares of 32.1% and 88.0%.
17. Bell County, Kentucky
> Poverty rate: 35.5%
> Adults with a bachelor’s degree: 9.2%
> Life expectancy at birth: 71.9 years
> Total population: 26,791
> Largest place in county: Middlesborough
Bell County, located in Kentucky’s southeastern corner, is one of many coal-producing counties in Appalachia to rank among the worst places to live. As is the case in much of the region, Bell County is characterized by widespread poverty and poor public health outcomes. The local poverty rate stands at 35.5%, more than double the 13.4% national rate. Additionally, life expectancy at birth in the county is about 72 years, seven years below the national average.
Across broad populations, both health outcomes and incomes tend to improve with educational attainment. In Bell County, only 9.2% of adults have a bachelor’s degree or higher, less than a third of the 32.1% share of adults nationwide who do.
16. Harlan County, Kentucky
> Poverty rate: 36.0%
> Adults with a bachelor’s degree: 10.8%
> Life expectancy at birth: 70.5 years
> Total population: 26,699
> Largest place in county: Cumberland
Harlan County, Kentucky, located in the state’s eastern coalfield region, is one of the worst places to live in the United States largely due to widespread poverty. An estimated 36% of local residents live below the poverty line, and nearly 19% of households earn less than $10,000 a year — more than triple the comparable share of households nationwide.
Life expectancy at birth in the county is also nearly nine years below the national average. This is attributable in part to the toll the opioid epidemic is taking on the local population. There are an average of 36 drug overdose deaths for every 100,000 people in the county annually, compared to about 21 per 100,000 nationwide.