The analysis focused on an area of 200,000 square miles that followed the Appalachian mountains from southern New York to northern Mississippi and that included all of West Virginia and parts of 12 other States. Forty-two percent of the 1998 population of about 22 million lived in rural areas, compared with 20 percent of the national population. The research used a data set compiled at the county level for all 399 counties in the region. The dependent variables were index crimes from Uniform Crime Reports during 1979-81 and 1989-91. Data relating to the independent and contextual variables came from the Bureau of the Census, Department of Agriculture, and Appalachian Regional Commission. Results revealed substantial demographic and socioeconomic diversity, as well as regional crime rates lower than those for the country as a whole, partly due to the predominantly nonmetropolitan character of the region. In addition, the spatial autocorrelation patterns of both violent and property crime indicated that these spatial patterns were not random. Moreover, the spatial autocorrelation patterns for violent crime indicated contagion or diffusion processes. Furthermore, significant differences existed for metropolitan and nonmetropolitan locations; subregional differences also existed in the clustering and spread of crime. Findings demonstrated the importance of incorporating spatial effects into empirical models of crime and suggested that global theories of crime may need modification or expansion to take spatial patterns and spatial dynamics more explicitly into account. Figures, tables, appended responses to reviewers’ comments, and 45 references