 The Appalachian region currently defined by the Commission includes 420 counties in 13 states, including 29 counties in North Carolina.The Commission gives each county one of five possible economic designations— distressed, at-risk, transitional, competitive, or attainment— with "distressed" counties being the most economically endangered and "attainment" counties being the most economically prosperous.These designations are based primarily on three indicators— three-year average unemployment rate, market income per capita, and poverty rate.