Book excerpt: Health and human service practitioners who work in Appalachia know that the typical “textbook” methods for dealing with clients often have little relevance in the context of Appalachian culture. Despite confronting behavior and values different from those of mainstream America, these professionals may be instructed to follow organizational mandates that are ineffective in mountain communities, subsequently drawing criticism from their clients for practices that are deemed insensitive or controversial. In Appalachian Cultural Competency, Susan E. Keefe has assembled fifteen essays by a multidisciplinary set of scholars and professionals, many nationally renowned for their work in the field of Appalachian studies. Together, these authors argue for the development of a cultural model of practice based on respect for local knowledge, the value of community diversity, and collaboration between professionals and local communities, groups, and individuals. The essays address issues of both practical and theoretical interest, from understanding rural mountain speech to tailoring mental health therapies for Appalachian clients. Other topics include employee assistance programs for Appalachian working-class women, ways of promoting wellness among the Eastern Cherokees, and understanding Appalachian death practices.Keefe advocates an approach to delivering health and social services that both acknowledges and responds to regional differences without casting judgments or creating damaging stereotypes and hierarchies. Often, she observes, the “reflexive” approach she advocates runs counter to formal professional training that is more suited to urban and non-Appalachian contexts. Health care professionals, mental health therapists, social workers, ministers, and others in social services will benefit from the specific cultural knowledge offered by contributors, illustrated by case studies in a myriad of fields and situations. Grounded in real, tested strategies—and illustrated clearly through the authors’ experiences—Appalachian Cultural Competency is an invaluable sourcebook, stressing the importance of cultural understanding between professionals and the Appalachian people they serve.