When 400,000 protesters descended on New York City for the People’s Climate March in September, organizers placed groups in a sort of environmental degradation hierarchy as the crowd snaked up Central Park West. In the front of the 30-block-long starting line were citizens who hailed from “impacted communities,” people whose lives and homes were directly affected by pollution and climate change. There were schoolchildren evicted from their flooded homes on Far Rockaway after Hurricane Sandy, homeowners from Pennsylvania whose groundwater had been polluted by fracking, and some of this country’s longest-suffering victims of environmental destruction—people from Appalachia, the heart of coal country. These old hands at protests and civil disobedience in their home states of Kentucky, Tennessee and Virginia carried signs that said, “Stop Mountaintop Removal,” and wore bright yellow T-shirts that commemorated a mountain in West Virginia that they had battled for and lost.

Because Appalachia is poor and its politicians are in the pockets of omnipotent coal companies, it is governed more like a Banana Republic than a representative democracy.

One of those groups was Appalachian Voices, a scrappy, grassroots environmental organization that I consider one of the most effective small environmental groups battling one of America’s greatest atrocities—mountaintop removal. This extreme form of mining gets to deep seams of coal not by digging tunnels but by blowing mountains in half, and scraping the residue into neighboring streams. Five hundred mountains in Appalachia have been destroyed; an area as large as the state of Delaware, and 2,000 miles of streams choked and contaminated. Not only is the land in Appalachia being systematically obliterated and turned into a barren moonscape (flying over this region will take your breath away) but its population is suffering near genocide. Recent studies show that people who live near mountaintop-removal (MTR) mines in Appalachia are 50 percent more likely to die from cancer than other people in the region, and their children are 42 percent more likely to be born with birth defects. The life expectancy of people who live near MTR sites is far below the national average, comparable to life expectancy in developing countries like Iran, Syria, El Salvador and Vietnam. Because Appalachia is poor and its politicians are in the pockets of omnipotent coal companies, it is governed more like a Banana Republic than a representative democracy.

Appalachian Voices was founded in 1997 and is based in Boone, North Carolina. Its small group of talented activist lawyers and scientists are tackling the woes of this region from the bottom up—from grassroots organizing to lobbying the halls of Congress. Appalachian Voices tests water for toxic waste, sues coal companies for pollution violations, lobbies Congress and federal agencies to strengthen protections meant to safeguard human health and the environment, supports local anti-pollution legislation, and educates the public about how to conserve energy and diversify the economy. “Here in Appalachia, the coal industry has dominated the economy for almost 100 years,” says Cat McCue, Appalachian Voices’s communications director. “At this point there’s little else to do in the coal-impacted counties; the industry’s influence over the years at the state and federal level has provided very little motivation to diversify the economy. If a coal job dries up, there’s really no other work.” Coal consumption in the U.S. is declining. Weaning Appalachia from the death grip of coal will require energy-hungry countries like India and China to take stock of the impact that the mining and burning of coal has on the health of their citizens and the temperature of the planet.

Writer and documentary film director Clara Bingham is a member of the board of directors of Appalachian Voices.