Utah wrote this song after a trip through West Virginia. They were having car trouble, and had stopped to get help filling up the radiator. There was a woman who helped them, and he started asking her about the people = why so many people in the towns seemed to want to get out and find work, while people in the hollers were more rooted - even though they were even more poor. She told him, "It's these hills. They keep you, and when they've got you they won't let you go."
The third verse ("Someday I'll come back to West Virginia") was written by Hazel Dickens and Alice Gerrard. It was a good addition, and sometimes he sang it. Other times he didn't.