Consequently, clinical and translational research in Kentucky communities has clear national applicability to all 2,308 nonmetropolitan (rural) counties in the United States, and especially to the 442 high-poverty counties, which tend to have the highest illness and death rates and the poorest quality-of-life measures. "If anything is unique about Appalachia, other than the stereotypical image developed and maintained in the wider culture, it may be the way that the region isolates and magnifies so many of the problems and the potential solutions that are more generic to American society."

Accordingly, the CCTS has as its centerpiece a plan for the engagement of rural communities, both as sites for the conduct of and training in clinical and translational research, and as sources of research ideas. The overall goal of this key function is to transform existing mechanisms and provide new programs to effectively engage communities in the "circularity of translation," and thereby dramatically accelerate the movement of basic discoveries validated in clinical trials to tangible improvements in the health and well-being of the people who live in these communities in Kentucky and across the country.