One of the defining features of our cultural moment is the speed with which the human race is becoming an urban species. The collection of social and economic trends that travel under the term “urbanization” undoubtedly bring unprecedented levels of dynamism and innovation to society as a whole. And yet, as is often the case, this dynamism casts a long shadow of instability—especially in communities struggling to keep pace with rapid social change.

This week we bring you two stories that give insight into the experience of those communities. The first is a devastating account of the human and social costs of the opioid crisis in Huntington, West Virginia. Andrew Joseph reports for STAT that Huntington medical professionals, who are now accustomed to treating two or three opioid overdoses per day, reported twenty-six overdoses in a roughly four-hour span last Monday—an outbreak that quickly occupied all of the city’s ambulances and more than a full shift of local police officers. Joseph describes Huntington as “among the most battle-scarred” cities in the fight against a growing opioid epidemic:

West Virginia has the highest rate of fatal drug overdoses of any state and the highest rate of babies born dependent on opioids among the 28 states that report data. But even compared with other communities in West Virginia, Huntington sees above-average rates of heroin use, overdose deaths, and drug-dependent newborns. Local officials estimate up to 10 percent of residents use opioids improperly.

He also tells us that things were not always this way in Huntington. Once known as the “Jewel City” due to its location on the Ohio River and proximity to a number of other growing cities at the turn of the 20th century, Huntington’s current population of 50,000 is roughly half of what it was in its post-war heyday. Though it is now, as one anthropologist has put it, “on the fuzzy edge” of the Rust Belt and suffering from the decline of local manufacturing, its economy has long persisted on a combination of light industry and natural resource extraction (coal and natural gas). Now, however, macroeconomic shifts have left many in Huntington behind.

The phenomenon of being left behind is also the subject of J.D. Vance’s recent memoir, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis. Though Vance (only 31 when he wrote the book) has in some sense transcended his hillbilly upbringing and “gotten out,” his first-person account illustrates the challenges facing America’s forgotten places—in this case, the small towns of Appalachia and the mid-sized cities of the Rust Belt. For example, in an interview with Rod Dreher for the American Conservative, Vance observes that “in my medium-sized Ohio county last year, deaths from drug addiction outnumbered deaths from natural causes.” Though Vance is clear that the root causes of this are multiple, he argues that, at bottom, the crisis in places like his native Middletown, Ohio is due to a form of “learned helplessness,” which Jennifer Senior’s review for the New York Times does not fail to highlight. There is, in this way, a kind of cultural despair at the heart of Vance’s book—some basic sense that patterns of destructive behavior can rarely (if ever) be fully undone. In the concluding pages of his memoir he writes:

People sometimes ask whether I think there’s anything we can do to “solve” the problems of my community. I know what they’re looking for: a magical public policy solution or an innovative government program. But these problems of faith, family, and culture aren’t like a Rubik’s Cube, and I don’t think that solutions (as most understand the term) really exist. A good friend, who worked for a time in the White House and cares deeply about the plight of the working class, once told me, “The best way to look at this might be to recognize that you probably can’t fix these things. They’ll always be around. But maybe you can put your thumb on the scale a little for the people at the margins.”

As Vance’s interview with Dreher shows, it’s clear that many circumstances largely outside his control contributed to his rise out of one of America’s forgotten places and into a position of relative security. And he does not deny the capacity of smart policies—like the ones that helped him to attend Ohio State University—to “put [a] thumb on the all-important scale” of social mobility. But it’s difficult to escape the sense that Vance’s story is a poignant exception that proves a unfortunate and disquieting rule.