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This paper analyzes Central Appalachia’s underdevelopment as an internal periphery and the emergence of a mode of extraction dominated by coal production. The metabolic restructuring of the social formations of this extractive periphery fed the developing centers of the US economy while ecologically degrading the region and increasing the vulnerability of the labor force to super-exploitation. As the US established itself as a core power in the world system the Central Appalachian region’s coal industry fed an unequal exchange of surplus labor and natural wealth. These relations were reproduced until the shifting balance of class forces at the national level undermined the conditions of labor exploitation through unionization associated with the New Deal.