The region's isolation led mountain musicians to make their own music for entertainment. It was not uncommon to encounter a remote mountain cabin with a homemade fiddle or banjo on the wall. Neighbors would gather at home to dance and enjoy local music. Musicians came to be influenced by the hymns they learned in church, and, as railroads and better roads opened up the region, by traveling minstrel and tent shows and urban "Tin Pan Alley" songs. Local writers, both Black and White, also began to craft "native" ballads, some based on older British ballads, incorporating local history and events, the most famous example being "John Henry."

When outsiders came to record local singers and bands in the 1920s, they usually found musicians with repertoires drawing from many sources, not the supposed "isolated" music of centuries before. The real traditional music of the region has continued to exist and thrive. Rediscovered time and again by outside audiences, it is dear to the people who make it and an important cultural resource. It is played by young and old, passed down by families and community members. The Mt. Rogers Combined School in Southwestern Virginia has a curriculum including old-time music, and East Tennessee State has a degree program in bluegrass.

At the weekly concerts and dances at the Carter Fold -- a venue run by Janette Carter in Hiltons, Virginia -- people from nine to ninety hit the dance floor the moment at the first notes of the band. Carter and her family built the Fold, a wooden amphitheatre remarkable for its old bus seats and wooden benches, to fulfill her promise to her father, A.P. Carter, to keep the music alive after his death. Visitors to the Fold range from neighbors down the road to tourists from Japan and Europe.

Religious spirituals, old-time music, bluegrass, work songs, country music, and various newer groups bending rules and creating something new out of old are all part of the soundscape. The music has a long heritage that continues today.