The Peer Recovery Support Specialist (PRSS), a certified professional who self-identifies as being in recovery from a substance use disorder (SUD), mental illness, or co-occurring disorders, plays a key role in the ongoing transformation of SUD treatment from one of acute clinical service provision with documented short-term outcomes including symptom reduction, to a more holistic and comprehensive approach to long-term recovery. Empirical evidence specific to outcomes of PRSS working in the addiction treatment realm is sparse and equivocal, indicating the need for additional research and improved methods designed to explore the nature of the PRSS role and fit within the expanding models of a recovery eco-system. This sequential exploratory mixed-methods study surveyed PRSS in five states of Central Appalachia in order to better understand the nature of their work, personal recovery characteristics and their interactions within existing recovery ecosystems. The final sample included 565 PRSS. Results indicate that PRSS frequently provide emotional support to persons they work with and are overwhelmingly satisfied with their work but have few professional advancement opportunities and generally feel that others misunderstand their role. They have a strong voice and wish to be heard as evidenced by their responses to open text questions and interest in future work. This baseline survey can serve as the beginning of a framework for improved methods if driven by PRSS.