With one of the weakest economies in the nation and a college attendance level lowest among the states, West Virginia has recently concentrated resources on combating its isolation from eastern markets and improving the quality of its public schools. The authors explore how West Virginians cope with these problems - compounded by the state's relatively high rates of occupational injury, teenage pregnancy, maternal health problems, heart disease, lung disease, and cancer - and how they choose to govern and be governed while seeking solutions. The authors argue that West Virginia's political system is affected by institutional rules, roles, and processes conditioned by the availability of economic resources. They examine the state's historical, political, judicial, and cultural practices, illuminating the policy consequences of limited institutional capacity on the economy, education, the environment, and healthcare.