I didn't grow up in the Appalachian part of Virginia, but my dad took us through rural parts of Virginia when we were growing up, and we saw some fairly run-down areas--by far NOT the worst. It was the easiest thing in the world for us to imagine why some people call Pennsylvania "Pittsburgh in the west, Philadelphia in the east and Alabama in the middle."
Although one of my grandfathers was from South Carolina, my parents grew up in New York. It took another generation for parts of my family to migrate back to the south. I have cousins in both New Hampshire and Tennessee.
But the reason why ignorance and choosing against common sense, as far as I can tell, has to do with two factors (if you exclude poor education). That would be the media and religion. The media for the obvious reason that all they watch is Fox "News" and actually believe what the hear (Republicanese: here) there (Republicanese: their). Religion, because religion is these areas is used for what it was originally meant: as a control tactic. "Do what I tell you, or terrible things will happen to you. I know this because God says so, and he talks only to me, so believe no one but me." This is not religion as a reasoned scholarly set of philosophical meditations, but religion as a primitive control mechanism that is a less physical method of control that requires fear of the unknown rather than fear of physical torture. It is far more effective when trying to control the masses. I met plenty of people who were suffering that proudly called themselves as "God-fearing," when they would have done themselves a far greater favor by being "starvation-fearing." But some people might get upset if they know that their starvation only serves nasty people and not God.
In the 19th century, Karl Marx wrote that "Religion ist das Opium des Volkes," opium being, in that day, a widely available pacifying pain killer. These days, beer and a TV screen blaring Fox "News" fills the same role--just as addictive, but more affordable and thus widespread--not only legal, but encouraged. No wonder we have such an uphill battle.
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