I grew up in semi-rural Virginia and recently watched Peter Santenello's Appalachia[1] series on YT. The reality is that WV is nearly entirely rural (like Wyoming, Montana, the Dakotas), but there's little oil or gas to backfill the coal, and it's absolutely not flat enough (and is almost entirely forested) for either meaningful factory/ranch farming or much else. It doesn't benefit from interstate commerce and there's no river running through it, either. Beyond all the topographical/geographical challenges, the cities are shells of their former selves, and since both the educational attainment and financial independence of West Virginians is low, the potential for breaking out of this death spiral seems low.

All that ... and then add the fact that WV is perhaps the worst hit state by the opioid crisis.

[1]: https://www.youtube.com/watch?v=h9lSZlDJAC0&list=PLEyPgwIPkH...

Tons of natural beauty and I think the state should continue investing in tourism along the lines of what Tennessee has done for decades with the Smokies.