Southwestern Virginia is much a part of Appalachia, and politically it is much like several states that Bill Clinton carried but Obama got trounced in -- Tennessee, West Virginia, Kentucky, and Arkansas, not to mention southern Missouri. Southern moderate populists like Bill Clinton, Jimmy Carter (in 1976), and Mark Warner can carry these regions as northern liberals can't.
Exactly. Kerry and Obama were poor fits for the region, while a candidate like Clark, Edwards, Warner, or Hillary would have done much better.