Mortality rates in Appalachia have not declined in recent years as they have for the remainder of the US. Appalachian mortality rates have actually increased. Most counties of southern West Virginia have mortality rates well in excess of the US average. West Virginia ranks at or near the bottom in most U.S. chronic disease categories, with the highest rate of drug overdose deaths and near the highest rates of cancer and cardiovascular mortality. And yet, West Virginia has many dedicated heath care providers, committed to the care of their patients. The West Virginia Clinical and Translational Science Institute (WVCTSI) seeks to facilitate finding solutions for vexing health problems in West Virginia, working with the many committed healthcare providers to collaboratively improve health outcomes in our state.