Some of this is retooling. You go from being a blue collar working town to a retirement town. Bluefield WV is an example. There is a large number of nice homes but few jobs to support them. Much of coal mining territory is cheap housing now.
West Virginia is the cheapest state in the country to buy a home.
I believe KY and IN are next in line.
Drugs are a major problem in WV. It was ground zero for the Opiod crisis. There were more Oxicotin pills given out in one WV county than anywhere else in the USA/World.