One of Andrew Sullivan's readers tries to make the point that Hillary Clinton has beaten Obama in Appalachia because she is "simply far better known" than he is. The reader then says that Clinton is a "scarred but resilient matriarch" and that in Appalachia, this "counts for a whole lot more than soaring rhetoric."

My cynical take is that there is a "Pathetic Hierachy of Bigotry" that remains prevalent in Appalachia:

Misogyny is less powerful than Racism which is less powerful than Homophobia. 

By no means does this characterize everyone in Appalachia, but I think it's a sad, but true rule of thumb for many.