America\u2019s 40 Worst Counties To Live In

The United States generated nearly $25.5 trillion in economic output in 2022, more than the combined gross domestic products of European and Central Asian countries, and about $7.5 trillion more than China, a country home to over four times as many people. However, the U.S. is also home to high levels of income inequality, and across the country, millions of Americans are not sharing in the country’s prosperity. 

Indicators related to health outcomes, financial security, and educational attainment offer a more comprehensive assessment of quality of life and development at the individual level than economic output alone. When taken together, these measures reveal, in many parts of the United States, a standard of living much lower than what might be expected in a highly-developed economy.

Using data from a range of sources, including the U.S. Census Bureau and the Centers for Disease Control and Prevention, 24/7 Wall St. identified the worst U.S. counties to live in. Counties and county equivalents were ranked on an equally weighted index of three measures – the poverty rate, the share of adults with a bachelor’s degree, and average life expectancy at birth. The measures chosen for the ranking were inspired by the United Nations Development Programme’s Human Development Index

In every county or county equivalent on this list, residents are far more likely to live below the poverty line than the typical American, and adults are less likely to have a college education. In the United States, both financial security and educational attainment are linked to health outcomes, and in each of the 40 places on this list, life expectancy at birth is over six years below the national average.

These counties are overwhelmingly concentrated in the South and the Midwest, while only three are in the West, and none are in the Northeast. 

Home to 12 of the worst counties to live in, Kentucky appears more times on this list than any other state. Most of these Kentucky counties, as well as several in West Virginia, have economies largely based around coal extraction, an industry that has been in decline for years. Between 2001 and 2021, U.S. coal production east of the Mississippi River declined by 56%. Today, much of Appalachian coal country has been devastated by poverty and hit especially hard by the opioid epidemic. (These are the counties in each state where the most people live in poverty.)

Several other counties on this list, mostly in the Midwest, are home to Native American reservations. Due to a number of historical and contemporary factors, many Native American reservations are among the poorest communities in the United States. In these places, economic opportunities are limited, serious financial hardship is widespread, and health outcomes are well below average. (These are the states with the shortest life expectancy.)

Click here to see the worst counties to live in.

To determine the worst U.S. counties to live in, 24/7 Wall St. constructed an index of three measures: poverty, bachelor’s degree attainment among adults, and average life expectancy at birth. The selection of these three measures was inspired by the United Nations’ Human Development Index.

Only counties or county equivalents with populations of at least 1,000 were considered. To better ensure geographic diversity, we only considered the lowest-ranking county in a given metropolitan area. 

Data on the share of individuals living below the poverty line, as well as the share of adults 25 and older with at least a bachelor’s degree came from the 2021 U.S. Census Bureau’s American Community Survey and are five-year estimates.

Data on average life expectancy at birth came from the Institute for Health Metrics and Evaluation of the University of Washington and are for 2019.

Supplemental data on population, median household income, and uninsured rate are five-year estimates from the ACS. Data on the number of annual drug overdose deaths per 100,000 residents came from the Centers for Disease Control and Prevention and is for the years 2018 to 2021.

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