The research presented in this paper explores the barriers to long-term disaster recovery in understudied rural communities in the eastern United States, along the Appalachian Mountains. This region, referred to as Appalachia, faces many of the same barriers to long-term disaster recovery as urban communities but also faces unique circumstances due to depressed socioeconomics, reduced access to public services, and the nominal capabilities of small, rural town governments. Devasting floods occurred throughout the eastern and central regions of Appalachia in 2016. Interviews were recently conducted with local, state, and federal government officials, nonprofit groups, and industry professionals about the long-term recovery efforts from this event. The findings highlight a multifaceted set of barriers. A total of twenty-two barriers are described, including limited economic resources, lack of flood insurance, slow allocation of funding, skilled labor shortages, unclear roles and responsibilities among stakeholders, a lack of long-term planning, regulatory delays, complex reimbursement processes, uncertain design standards, an attachment to flood-prone regions, and a lack of knowledge of building codes. Many of these barriers compound each other. Future research is needed to develop solutions that address these barriers for small, rural communities still straining to recover from a disaster that occurred years ago.