The Appalachian Region, as defined by Congress, stretches more than 1,000 miles from northeastern Mississippi to the southern tier of New York. Spanning 205,000 square miles in 420 counties across 13 states, Appalachia is home to 25 million people and to diverse economic, social, and natural landscapes. The Appalachian Region confronts a combination of challenges that few other parts of the country face-mountainous terrain, dispersed population, environmental issues, and lack of financial and human capital. While the Region has a wide array of natural and human resources to meet these challenges, its rate of economic growth and development has not kept pace with that of the nation. This report provides a profile of the people, the economy, and the natural resources of the Appalachian Region. The well-being of the Appalachian people, the core objective of any development strategy, remains below the national average on a vast range of key indicators, including employment and earnings levels, household income levels, poverty rates, and educational attainment. In addition, Appalachia has higher rates of serious disease, mortality, and disability than the nation as a whole, and in some areas of the Region it is difficult to access treatment and affordable health care. Some Appalachian communities also lack the physical infrastructure necessary to create robust, sustainable local economies, such as adequate water and sewer systems and broadband access. Each subregion of Appalachia faces unique challenges. In Central Appalachia, persistent socioeconomic distress and out-migration have resulted in a significant gap in human, natural, and financial capital, which greatly hinders economic development. Northern Appalachia continues to work to overcome deindustrialization and depopulation, and to develop niche industries to restore stability to the regional economy. Southern Appalachia has generally enjoyed relatively high population and job growth over the past few decades due to its focus on preserving and enhancing its manufacturing-based economy. The consistent contrast between regional and national measures of well-being is at odds with a region possessing abundant natural resources and enjoying significant locational advantages. The Region's large reserves of energy and water have provided a solid base for traditional industries such as farming, forestry, mining, and manufacturing. However, patterns in global trade and technology have shaken Appalachia's historic economic reliance on its natural resources and disrupted many local economies that were already fragile. The combination of these special problems in Appalachia has resulted in concentrated areas of poverty and unemployment. And while the Region has a wealth of natural resources that have benefited the nation, those resources have not generated the level of economic stability, employment, and prosperity that is found across the rest of the nation. The development of new strategies for the growth and diversification of Appalachia's economy must therefore account not only for the challenges and opportunities facing Appalachia, but also for the tremendous diversity of needs and assets across the Region.