VALLSCREEK, W.Va. — Sonny Barton drives slowly down the rugged gravel road from his home atop Whitaker Ridge, two huge, empty containers strapped in his truck bed and water weighing heavily on his mind.

Fifteen minutes later, he pulls up along a creek, unfurls a thick hose — a gift from the fire department — and hooks it to a gas-powered pump. While he and his wife, Lena, wait for each of the 300-gallon plastic containers to fill, their grandchildren try to trap the crayfish darting among the rocks, just as their parents did before them.

Barton has made this weekly excursion for four decades. It always ends back up the mountain, where he empties the tanks into his home cistern, sanitizes the contents with bleach, then pumps it into his home for bathing and washing clothes. If the former logger doesn’t haul the water himself, the taps run dry.

Some of the drive feels otherworldly, with canopies of trees resembling the old-growth forests that once covered Appalachia. Both distance and terrain matter for the seven households that live in this remote corner of McDowell County, not far from the Virginia border. Their community is more than three miles from the cutoff point for the local water utility.

Barton remembers a meeting at the fire hall in the late 1980s where, by his account, an official promised that the water would make its way into the hollow. “They should have stayed with that word,” he says. “The younger ones would probably stay if they had water. None of them like it up here because you have to haul water.”

More than 2 million Americans live without running water and indoor plumbing, a reality felt acutely in certain regions across the country, according to a joint 2019 report from the nonprofits DigDeep and U.S. Water Alliance. The problem hits hard in Appalachia, as well as in central Mississippi and Alabama, the colonias along the Texas-Mexico border, the Navajo Nation in the Southwest, and California’s Central Valley.

There’s also a significant “water access gap” in Alaska and Maine. Indeed, as the report notes, “small pockets of communities without complete plumbing exist in every state.” Most are rural and communities of color. All face high poverty. Despite President Biden’s pledge to tackle environmental justice issues, his proposed $111 billion investment in the nation’s water infrastructure isn’t really aimed at these communities’ challenges.

In McDowell, estimates suggest that at least a third to half of the roughly 17,600 residents have trouble with their water or sewer systems. For some, wells have become contaminated after gas drilling in the area. A special initiative ultimately will provide clean, safe running water to several hundred homes, but it’s a daunting goal. Solutions are as complex as the systems themselves and will require a combination of money, skill, workers and compassion — all but the last in short supply here.

Collecting water and lugging it home, whether in bottles, tanks or gallon jugs, is a practice shared by generations of families in the state’s southern coal fields. Nikki Sparks worries about its toll on Barton, her stepfather.

“There’s some times his knee will kill him,” she said after one of his runs last month. “There’s some times he can’t even get in the truck.”

The process hasn’t been without consequences for Sparks either. Four years ago, she was driving water back up the mountain with Barton when an all-terrain vehicle spun suddenly in front of her. The truck jerked as she tried to maneuver, toppling one of the tanks, which even empty can weigh 80 pounds.

Though five months pregnant, she strained to help Barton lift the container. Two weeks later, she learned she’d lost her baby. “I grieve my way [by] having a birthday party for her every year,” Sparks said.

She and her husband, Wayne, get their supply from a nearby spring; its constant flow of water feels safer for them and their three children than what comes out of the creek. They make the trip about once a week and use their mountain source for everything but drinking.

Of course, springs can carry their own risks. In 2019, Virginia Tech researchers tested 21 springs in five states in Appalachia, including West Virginia. They found E. coli in most of them.

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In the mid-20th century, McDowell led all other U.S. counties in coal production. Then machine technology began replacing coal jobs, and the 1950 population of nearly 100,000 declined by more than a quarter over the next decade.

The city of Welch, the county’s governmental center, once boasted dozens of multistory retail and apartment buildings collectively known as “Little New York,” an image difficult to square with today’s empty storefronts and vacant properties. Seven miles to the east in Kimball, the Walmart Supercenter has been shuttered for five years. McDowell may have lost 20 percent of its population since 2010, if census projections were on track, further chipping away at its tax base. About a third of its residents live in poverty.

Unlike for the families in Vallscreek, getting connected to safe, dependable water is logistically possible for thousands of other county residents: The infrastructure exists but needs upgrading, a costly undertaking dependent on outside dollars.

“Appalachians face the same problem that millions of other Americans do with access to water: degrading infrastructure and problems around sanitation,” said George McGraw, chief executive of the Los Angeles-based DigDeep. Yet the “constellation of drivers and impacts in Appalachia is incredibly unique.”

Many McDowell residents live in towns once run by coal companies that operated their own utilities and replaced lines and pumps when they failed. Mavis Brewster heads the water and sewer utility that formed in 1990 to assist the communities that inherited this infrastructure — some of it nearly a century old — when those companies left. She admits that collecting on bills is difficult given the county’s low income and high unemployment. Despite its shoestring budget, the utility still has been “very aggressive” about trying to keep pace, she said.

“Water is a very basic need — water and sewer,” Brewster said. “Every person in the United States, in the state of West Virginia and McDowell County, every person deserves to have water available to them.”

Even so, some residents have experienced frequent water outages and lived under a constant boil-water advisory for years.

Keith Godfrey continues to grapple with intermittent outages at the two county clinics run by the Tug River Health Association, where he is maintenance director. He usually stores jugs and buckets of water in the basements at both sites for flushing toilets if the water suddenly cuts off. That happened as recently as late May at the clinic in Gary, and Godfrey drove seven miles to fill containers at a co-worker’s house. When he returned, the water was back on.

The disruption was a mere inconvenience compared with the situation last August. Two town pumps broke down, and no one had water for a week. The fire department filled a 55-gallon barrel for the clinic staff’s temporary use, while the county’s economic development office paid to replace one pump. Gary then got emergency funding to buy three more.

“We didn’t have the money. It was tough,” said Mayor Larry Hairston, whose town was built by financier J.P. Morgan to ensure he had coal to power his steel mills. Gary was incorporated in 1971, and while U.S. Steel did some water system upkeep and repairs during the next decade, the support stopped when the mines closed in 1982.

A multimillion-dollar project that began in 2014, backed by federal, state and local grants, is set to extend service to more former coal towns here and make repairs for existing customers. But exactly what is owed to small communities in decline?

West Virginia is aiming greater efforts elsewhere because of its own population loss. A public-private program is offering $12,000 awards, plus year-long passes for white-water rafting, skiing and other outdoor activities, to entice remote workers to move to the state.

The first target destinations are Morgantown, Shepherdstown and Lewisburg. Those are three of West Virginia’s most prosperous towns, hours from the southern coal fields and McDowell County.

“It seems like we just get left behind, this part of the country,” Godfrey said.

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On the lawn next to the Five Loaves and Two Fishes food bank in Kimball sits a cluster of “hydropanels” that function like dehumidifiers, pulling in outside air and pushing it through a system that traps the water vapor and turns it into drinking water. With regular sunlight and good temperatures, the panels can produce up to 190 gallons every few weeks. The food bank bottles and distributes that free to those in need.

“It’s the purest in West Virginia,” said Linda McKinney, director of the food bank, which serves up to 250 families each month. “You don’t find water like this.”

DigDeep installed the panels and then went a step further and hired Linda’s husband to lead its Appalachia Water Project. Bob McKinney is a retired master electrician, water plant operator, educator and mine supervisor, plus a retired pastor accustomed to listening to people’s concerns. As he visited families across McDowell — some in hollows he’d never seen before — he helped establish buy-in for the project.

Those conversations educated him, too. Bottled water is the food bank’s most requested item, but he didn’t grasp the depth of the problem. “I didn’t realize there was such a need,” he said recently.

DigDeep is covering the costs of physically connecting people’s homes to new high-pressure water lines paid for by the county utility — a cost of roughly $1,600 per property. The nonprofit, which currently focuses only on U.S. water infrastructure, is funded primarily through grass-roots donations, according to its chief executive.

Since March, McKinney and his team have laid service lines to the homes of at least 100 customers. Contractors should be ready to turn on the water by the end of the July.

But the workforce deficit remains a perennial concern. McKinney has resources to build a team but has just one water technician at the moment. Water lines that DigDeep planned to start installing in another community are delayed because the county utility is also so short-staffed.

Other solutions will be needed for more-distant neighbors in places like Vallscreek.

Brewster is talking to the provider in the Virginia jurisdiction bordering McDowell about the possibility of extending service to the Bartons’ hollow because of its proximity to the state line. And McKinney is mulling water kiosks that could be located where the county water service ends; they would allow families to fill up much as steam locomotives once did when they pulled into train stations.

“People are doing the best they can. It’s just a slow process,” McKinney said.

He tries to stay optimistic, though he’s concerned about history repeating itself.

“After all this is said and done . . . and all the lines are run,” he wonders, “in 10 years from now, are we going to be in the same situation?”