The Appalachian Region has long suffered from poor economic performance as measured over a variety of dimensions. Even as the region has improved over the last few decades, Appalachia still lags behind the nation. A growing body of empirical work has found that reallocation is pervasive in the U.S. economy and is an integral component of economic growth. Productivity growth is improved when resources are shifted from less productive establishments towards more productive establishments either through changes in existing establishments or through the births and deaths of establishments. Establishments that use new products, technologies, and production processes replace establishments that do not in a continual process of creative destruction. Using establishment-level data, this paper examines the reallocation and productivity dynamics of the Appalachian Region. The first part of the paper compares the reallocation dynamics of Appalachia to the rest of the U.S. using a newly developed establishment-level database that covers virtually the entire U.S. economy. From this analysis, it is apparent that establishment birth and death rates and job creation and destruction rates for Appalachia are consistently below those for the rest of the U.S.. The second part of the paper uses data from the Economic Censuses to determine whether the establishment and employment dynamics of the Appalachian Region are also qualitatively different (in terms of their productivity rankings) from their U.S. counterparts. It appears that the North subregion of Appalachia has reallocation and productivity dynamics that are consistent with an impeded creative destruction story.