This report analyzes trends in household and family structure in Appalachia from 1990 to 2000. The lack of jobs in the Appalachian Region–combined with the recent declines in public assistance income–presents special challenges to families living in Appalachia’s poorest communities. This report investigates household and family change in the context of Appalachia’s unique economic environment, with a focus on female-headed families, families with children, nonfamily households, and households headed by older Americans. Racial/ethnic, rural/urban, and regional trends in Appalachia are compared with trends in the United States as a whole.