Poverty levels, average property values, employment rate, opioid usage. You can just see that infrastructure is in better shape. A couple of those river towns are definitely pretty rough, but compared to Appalachia, it still looks alright. There's plenty of rural decline here, but it is MUCH slower than in most of the rest of the country. Particularly north of I-80 where you can actually find rural towns that have gained population.
Since 1950, West Virginia has lost 300,000 people. In that time, Iowa's added 500,000. That's nearly a million person swing between the two in small states.
Acting like Iowa has become Appalachia is simply inaccurate.