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ABSTRACT Appalachia remains a symbol of poverty in the midst of prosperity. During the 1990s it fell further behind the rest of the nation. Persistent poverty during a period of strong growth is a serious as well as an interesting subject to study. We examine determinants of growth in Appalachia between 1990 and 2000. We show that employment, migration, and median household income were jointly determined by regional covariates and that county economic conditions were conditional on the performance in neighboring counties. One conclusion is that regional cooperation and geographically focused programs may yield the greatest returns to policy investments.