The residents of Drake, West Virginia, have to make a difficult choice between their own health and the need for work. The mail carrier Howard Reed suffers lung, kidney, and liver damage from a lifetime of breathing coal dust and exposure to other pollutants in the air and water, yet he feels he can’t call attention to those issues without angering his neighbors who depend on the mine for jobs. Later, Cole shows Puller some of the ruined landscape—valleys filled with everything stripped off the mountain’s surface, rivers blocked and diverted, flash flooding. She tells him about cancer clusters, lung damage, and other chronic sickness among the town’s residents.

Cole also mentions more than once to Puller that jobs are an issue. People living in the midst of environmental damage and degradation have to make a pragmatic choice between food and shelter now versus health problems and possible shortened lifespan in the future. In that circumstance, immediate survival almost always wins.

At the same time, the economy is eroding along with the environment. The residents of Drake are losing even the one benefit that mining provides to the community. Surface mining creates fewer jobs than older methods, and a growing segment of the population is losing homes and livelihoods and being forced to live in abandoned housing.