Chronic poverty grips regions across the United States, and leaves urban and rural residents alike in struggles for employment, housing and some of life's basic necessities. It often also leaves poor Americans exposed to pollution and environmental degradation which can produce a range of health problems.

Natural resource extraction has affected environmental quality in areas of the U.S., leaving impoverished communities exposed. Appalachia, a region with a poverty ratenearly five percent higher than the national average in 2008, is home to mountaintop removal (MTR) coal mining. MTR, which uses explosives to expose coal seams under the surfaces of mountains, has been the target of protests across the region as the coal industry challenged and defeated EPA rules in court.

In a 2011 study, the mining practice was linked to greater instances of birth defects. HuffPost's Travis Donovan reported that the study, published in Environmental Research, "examined over 1.8 million live birth records from 1996 to 2003 using National Center for Health Statistics data from the central Appalachian states of West Virginia, Virginia, Kentucky and Tennessee." They found that babies born near MTR sites had "significantly higher" rates of several birth defects.