In the nineteenth century, the perceived ability of alienists (the early term for mental health specialists) to cure insanity eventually led to lavishly-constructed insane asylums supported by taxpayers. Simultaneously, the hope of a cure and a changing attitude toward insanity helped destigmatize mental illness and made institutionalization of the insane more acceptable. This regional study investigates insane asylums within Appalachia between 1850 and 1900. Primary sources include period articles from professional publications, census data, asylum records, period newspaper articles, and patient records. The study provides background on the medical environment of nineteenth-century Appalachia and investigates the creation and function of five Appalachian asylums. The institutions under examination appear to be as modern and enlightened as those in any other region. Contrary to most published theory, women were not committed to Appalachian asylums more often than men, nor does patient abuse appear to be prevalent.