Broadband & Telehealth in N.C.'s Appalachian Coal-Impacted Communities

Cover of 'Carolina Crosscut: Broadband and Telehealth in North Carolina’s Appalachian Coal-Impacted Communities' Report
Download the "Carolina Crosscut" Report

The rapid and widespread decline of the coal industry has had a negative impact on many of North Carolina’s Appalachian communities. The region’s traditional resources have been depleted. Work force opportunities and tax bases have decreased, local hospitals have closed, and generational dependence on coal extraction and related supply chains has resulted in personal and community economic devastation.

The Broadband Infrastructure Office and the N.C. Department of Health and Human Services Office of Rural Health conducted a feasibility study that examined the broadband, health care and telehealth assets – including the health disparities and broadband gaps as well as opportunities – for the 20 counties1 in North Carolina’s Appalachian region that are most affected by the coal industry.

The study confirmed that:

  • A disproportionate number of individuals in the study area live without access to basic health care services and access to specialists, such as cardiologists, because of distance and limited provider availability.
  • Health care access is improved in areas where broadband and telehealth services exist.
  • Patients are more aware of their conditions and equipped with self-management techniques to seek medical care when concerns arise.

1Counties that were part of the study are: Alleghany, Ashe, Avery, Burke, Caldwell, Cherokee, Forsyth, Graham, Haywood, Henderson, Jackson, Macon, Madison, Mitchell, Rutherford, Surry, Transylvania, Watauga, Wilkes and Yancey.

Report & Data

Below are links to the published study as well as two dashboards that provide visualizations of the data gathered.2

2All data collected was prior to March 2020, the start of the COVID-19 crisis in North Carolina.


In February 2019, the Appalachian Regional Commission awarded the Broadband Infrastructure Office and the N.C. Department of Health and Human Services Office of Rural Health a $98,273 Partnerships for Opportunity and Workforce and Economic Recovery (POWER) grant for a technical assistance feasibility study project to increase broadband access, adoption and use and the implementation of telehealth services.  

The study gathered data and best practices to inform the design of a comprehensive plan and provides essential information for the state and local stakeholders to design pilot programs to improve local economies – specifically programs that:

  • Leverage technology to provide appropriate clinical interventions
  • Improve the local population’s health
  • Increase local work force participation

Through the study, the project team gathered data on:

  • Broadband access
  • Broadband adoption
  • The number of deaths due to the region’s most prevalent diseases
  • Current telehealth usage
  • Locations of community anchor institutions, such as safety net sites, libraries, and schools that serve as anchors and trusted resources in their communities

Although many of the data points existed prior to this study, compiling the data provided a new and interesting lens through which state and local leaders can view the counties and identify new partners and areas ripe for piloting new technologies.

The compiled data also identifies areas that leaders should target to expand broadband or provide technical assistance.