What is wrong with this state?
Well, what do Clinton and Sanders have to offer it, really?
Appalachian coal country's problems are so severe, so acute, and so different from those of most of the rest of the country that a Democratic campaign that was really interested in competing for its vote qua its vote would have to devote a great deal of time, attention, and energy
specifically to crafting policies to help ameliorate those problems, and even more time, attention, and energy to selling those policies. Personally I think there should be somebody doing this (and would have hoped, in the past, that Sanders might), but that isn't how things are going this cycle.