Photo: Andrew Caballero-Reynolds/AFP via Getty Images

By the usual standards, Dr. Starla Kiser is the perfect Democratic candidate for her state House district in rural southwestern Virginia. A self-described moderate, the 35-year-old Kiser grew up on a farm in Dickenson County and graduated from tiny Ervinton High School, one of a number of coalfield high schools that have closed or been consolidated over the last decade. Kiser attended East Tennessee State University and went on to Harvard Medical School. In 2017, the Chicago-based health care start-up where she worked closed its doors, and she decided to move back home. “I was able to get medical supplies donated,” she told me in late July. “So I just took the leap. I got it all in the U-Haul and I was like, you know, I’m doing it. It felt like the right time.”

From her clinic in Wise, Virginia, Kiser cares for a base of low-income patients. There’s a monthly membership fee: $35 a month for pediatric patients, $65 a month for adults under 60, $80 for seniors. It’s an expense, but before the state expanded Medicaid, Kiser’s fee was significantly less burdensome than private health insurance. Even now, she says, clients still rely on the clinic for access to preventative care. Keeping the clinic open is one challenge. On Tuesday she’ll face another, when voters in the Fourth District decide whether she’ll take an open seat in Virginia’s House of Delegates.

Kiser’s campaign faces significant obstacles. Her Republican opponent is formidable. Wiliam Wampler III didn’t exactly grow up working class in Dickenson County. In fact, he belongs to a local Republican dynasty: His grandfather served in the House of Representatives, and his father in the State Senate. Their influence is regional. Take the I-81 from Christiansburg to Bristol, an hour away from Wise, and a sign tells you that you’re on the William Wampler Sr. Memorial Highway.

But more important than her foe is the political terrain upon which the election will be waged. Though her district was Democratic for decades, she is the first Democrat to run for the seat in five years, and Trump won the district by 57 points in 2016. Southwest Virginia has shifted further to the right with time, and the days of victorious coalfield Democrats feel distant indeed.

Polarization is a familiar foe. The subject has inspired a thousand op-eds since Donald Trump took office. But rural voters aren’t just rejecting the Democratic Party because of the power of Fox News. A closer examination of voting patterns reveals a varied set of complicated forces at work. In economically deprived areas, voter turnout tends to be low, and that affects portions of rural America, too. Even in 2016, the year that yoked them to Donald Trump in the national imagination, many counties in central Appalachia posted turnout levels below the national average. The trend isn’t new, but it’s not static, either. The Daily Yonder, a website that covers rural issues, reported that Democrats did make up some ground with rural voters in 2018 — an improvement that corresponds, probably not coincidentally, with an increase in the number of Democrats running for office nationwide. Voters respond to effort. When they shift allegiances or stay home altogether, they tell us something urgent about the quality of a party’s outreach, and help clarify the barriers in its path to victory. In rural areas like southwest Virginia, the biggest challenge faced by Democrats like Kiser might not be the popularity of Trump, but voter alienation. If Kiser is an underdog, it’s due in part to decisions made by party strategists in offices far from her native Dickenson County.

Jane Fleming Kleeb, the chair of the Nebraska Democratic Party, has criticized party leaders for what she characterizes as their neglect of rural constituencies. “I think one of the biggest problems that we are facing, and this may sound so simple to say, is that none of our national party leaders live in a rural community,” she said. “When you’re looking at a candidate in a rural community and you’re not from a rural community, you don’t see the path to victory.”

People who actually live in those communities, she added, “know what is possible and how to win.”

Republican control has not been good for rural people. Jobs are scarce, young people are leaving, and suicide rates are up. Days before I met Kiser in Wise, the Blackjewel coal company abruptly declared bankruptcy. The company’s demise cost the region a thousand jobs, and it owed laid-off miners millions of dollars in back pay. Miners received a fraction of what they’re due this month, after a weeks-long protest blocked Blackjewel coal trains from leaving nearby Harlan, Kentucky. As the miners of southwest Virginia contemplate the demise of the area’s core industry, the recent merger of two local hospital systems provoked widespread outrage. The birth of Ballad Health created a health-care monopoly in the region, and its decision to close some local hospitals and consolidate specialized care in a few locations sparked ongoing protests.

Rural communities are sites of resilience and revitalization, too. Some young people do stay, or, like Kiser, come home. Overall, though, the data is clear. Many rural people are in dire circumstances, especially if they live on reservations or on the southern border, often as a direct result of Republican policies that deprive public institutions of funds while subsidizing private industries like coal and natural gas. In a two-party system, the solution, ostensibly, is to elect Democrats. But sometimes the party doesn’t even run candidates for local seats, or if they do run candidates, they sound like watered-down versions of the Republican candidates. In either case, voters have few reasons to choose any Democratic candidate, whether she’s running for state delegate or president. That places rural organizers in a difficult position, whether their objective is to pass a ballot initiative like Medicaid expansion, or to put a candidate in office.

In West Virginia, some organizers have decided that the way to move the state forward is to organize outside the Democratic Party altogether. Community organizer Stephen Smith is challenging incumbent governor Jim Justice, but his is not a typical race. Smith, who helped found the West Virginia affiliate of the Working Families Party, is running for office under the banner of West Virginia Can’t Wait. Launched in November 2018, the nonpartisan organization provides training and support to candidates who sign its pledge to reject corporate money and hold at least 25 meetings with voters before formally filing to run for office. Most candidates who take the pledge are Democrats, but a few local Republicans have signed on, too.

Smith himself has professed left-wing positions on policies like Medicare for All, and is running for office as a Democrat. But in a September conversation, Smith rejected the “progressive” label, just as he did in an earlier interview with the Intercept. “There’s a lot of people who use that term at the national level as sort of a code word and a lot of those people haven’t done much for West Virginia,” he told me. He prefers a different, and less overtly partisan, model of change. “We think the conventional wisdom is wrong, that to approach places like West Virginia and other rural areas in a left versus right way completely misunderstands them,” he said. “In West Virginia and in most rural places in America, the fight is not left versus right at all. It’s the good old boys versus everyone else.”

The Can’t Wait campaign isn’t necessarily about electing Democrats, but about fundamentally changing the makeup of the state’s political class. Smith, who was recently endorsed by Senator Elizabeth Warren and has been the subject of two recent profiles in the Intercept and The American Prospect, is the campaign’s most visible public face. But Can’t Wait has ambitions bigger than the governor’s mansion: It wants to build a movement. The group now has a presence in each of the state’s 55 counties, where county captains direct organizing at the local level. It also runs 39 teams committed to organizing specific demographics and communities, a tactic that builds on recent populist momentum in the state. In 2018, West Virginia teachers walked out of class and helped spark a nationwide wave of school staff strikes; in 2019, many walked out for a second time after Republican lawmakers tried to pass a bill that would have created some charter schools in a state that previously had none. Now they can join Educators Can’t Wait, an organizing group under the banner of the statewide campaign, and work to oust the lawmakers who made their walkouts necessary. People living with substance-use disorders are too often a footnote in national stories about rural poverty, but now they, too, can join their own organizing team, called People in Recovery Can’t Wait. In November, they’ll help determine Smith’s formal platform at a statewide convention. It’s a grassroots infrastructure with no precise precedent in the state.

Candidates believe the campaign’s organizing strategy will also help resolve a familiar problem: voter turnout. “I think turnout is low because both political parties have abandoned rural America,” said Cathy Kunkel, a Can’t Wait candidate running in the state’s Second Congressional District. “That’s it in a nutshell.”

At the national level, the Democratic Party is coming around to the idea that it needs rural votes. “I tell Chair Perez this, and Speaker Nancy Pelosi was just in Nebraska two days ago and I said this to her as well, we cannot continue to starve state parties and think that somehow we are magically going to come up with some unicorn of a candidate that is going to turn things around,” said Kleeb. She adds that things have improved recently: Her state party is now getting $10,000 a month from the Democratic National Committee, as opposed to $2,500 a month while President Obama was in office.

But in other respects, the party’s progress is slow, maybe too slow for first-time candidates like Starla Kiser. (Kleeb notes that her state party used to get $25,000 a month.) And when prominent Democrats do reckon publicly with rural apathy, their diagnosis of the problem sometimes says more about the party’s internal ideological divisions than it does about the material needs of rural people. After Senator Claire McCaskill lost reelection in Missouri, she blamed the left for making the Democratic brand unpalatable to her rural constituency. “This demand for purity, this looking down your nose at people who want to compromise, is a recipe for disaster for the Democrats,” she told NPR. “Will we ever get to a majority in the Senate again, much less to 60, if we do not have some moderates in our party?” Two other losing red-state senators, Heidi Heitkamp of North Dakota and Joe Donnelly of Indiana, launched the One Country Project to try to help Democrats bring rural voters into the fold. “You’ve got to show up, but you can’t show up empty-handed,” Heitkamp told Washington Post columnist Jennifer Rubin in May.

What offerings, then, should Democrats bring to the hills and the prairie and the woods? For McCaskill and Heitkamp, the answer defines itself against the positions of the left. Take Medicare for All, the policy of the moment. Heitkamp opposes it, as do Donnelly and McCaskill. As reported by the Intercept, the One Country Project itself has links to the same lobbying firm behind the Partnership for America’s Health Care Future, which campaigns against Medicare for All. The three former senators share a familiar logic. They conflate rural with a preference for centrist or even conservative policies and rhetoric. In this vision, rural America is still Trump country. Its residents will budge so far and no further, so the naïveté of the left threatens the party’s survival.

McCaskill and others have kicked up a lot of noise, but it’s less audible the further you get from D.C. Stephen Smith isn’t the only voice insisting that the traditional binaries — left versus right, or even progressive versus moderate — fail to adequately explain rural points of view. “We do a whole training for all our volunteers that is about how the left versus right polarization is really the language of the political class,” said Jonathan Smucker, a community organizer who works with Lancaster Stand Up in rural Pennsylvania. Smucker, a supporter of Bernie Sanders, says that in his experience, rural voters “have complex positions,” even “contradictory positions on the same issues.” Sometimes that complexity can benefit left-of-center candidates. Smucker brings up Conor Lamb, the Democrat who represents Pennsylvania’s 17th Congressional District. Though Lamb is often called a moderate in the press, Smucker says his race was “absolutely misinterpreted.”

“On guns and abortion, he played down those issues, certainly. You could argue that on those issues, he was not saying the most liberal thing,” Smucker added. (Lamb is pro-choice, however, and supports some new gun-control measures.) “On labor, on picking fights with corporate power? He was one of the most pro-labor candidates in Pennsylvania. He’s not at all Third Way. It’s kind of crazy that they’re claiming him.”

Similarly, rural voters might not share Heitkamp’s antipathy for Medicare for All. In one recent Harvard/Harris poll, 55 percent of rural voters said they support the policy. Polling on Medicare for All is complicated, and public support tends to fluctuate based on how the policy’s described. But there’s good reason to think that Medicare for All isn’t kryptonite for rural voters. Perhaps there is no kryptonite all — no policy so powerful it can either destroy or save a rural campaign on its own. “I think that is one of the biggest mistakes that Democrats have made over the past ten years,” Kleeb said bluntly. “They think all rural voters are right-wing conservatives. And it’s just not true. There are communities of color in our rural communities. There are family farmers and ranchers, who are often very fiercely independent and often progressive populists on issues.” Winning back rural America will take years of showing up, years of running candidates whose platforms and outreach strategies convince voters not only that they’re listening, but that they’re ready to fight. Kleeb, who endorsed Sanders in the 2016 primary, says there is no singular message or position that will appeal to rural voters.

For all the prestidigitation that envelops them, rural voters are just people, and people aren’t that difficult to understand. “People in this area,” Kiser said, “know that the economy is doing great globally, and that a slice of the economy is doing great here. But people know intuitively when they go on Facebook and they see a business being closed that we’re not seeing that same progress.”