Problems in the Appalachian region are described in this report. The realities of deprivation are documented through low income, high unemployment, lack of urbanization, deficits in education, deficits in living standards, and a changing citizenry. It is noted that the program recommendations must be regarded as a total effort. The Commission identifies 4 priority areas for immediate investment: the provision of access to and within the region, programs to more fully use the region's great natural resources, construction of facilities to control and exploit the abundant rainfall of Appalachia, and programs which obtain immediate improvements in human resources. The major recommendation of the Commission is that the Federal, state, and local governments act in concert within a framework which permits their cooperation and encourages private initiative. (PS)