When you think about rural America, what do you imagine? Quaint little towns with general stores? How about poverty, opiate addiction, and teen pregnancy? Employment opportunities are dwindling, educational quality is falling, and healthcare access is becoming increasingly more difficult. These are only a few of the issues that are plaguing our small towns; however, it seems as though rural America is struggling alone and unnoticed. In this talk, I will present some of the greatest problems facing our small towns and compare them with urban trends. I will also specifically focus on the vulnerable people of Appalachia. This will be an interactive session, as I will invite attendees to help me brainstorm what our response can be to the crisis occurring in rural America.