Desperate for Workers but Dead Set Against Migrant Labor: The West Virginia Dilemma. Credit: The Wall Street Journal

FRANKLIN, WEST VIRGINIA—Not many places need warm bodies more than this picturesque town in the Appalachian Mountains. There are so many elderly people and so few workers to take care of them that some old folks have died before getting off the wait list for home visits by health aides.

“We advertise all the time,” said Janice Lantz, the local senior center’s director. “We can’t hire a direct-care worker.”

West Virginia shares a demographic dilemma afflicting many parts of the country: an aging population and unfilled jobs. Decades of migration out of Appalachia have left West Virginia older, less educated and less able to work than other parts of the U.S. Its labor-force participation rate—the share of the 16-and-older population either working or looking for work—was 55.2% in March, the second-lowest in the country.

Some other states, including Maine, Indiana and Utah, have sought immigrants to shore up their workforces. But while West Virginia represents one extreme in its labor […]

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