Both times I was there (for mission work) I asked the young adults to consider moving out and finding jobs in the rest of the country. Every time the response was that they're not moving from their home, despite the poverty. (FYI, you get the same response when you volunteer in the deep poverty of Alabama's Black Belt.)
Looks like Vance is one of the few who decided on the moving out option through the Marines.
Vance grew up in Middletown, Ohio, about halfway between Cincinnati and Dayton. He is of Appalachian stock, but did not grow up in Appalachia.