Middle Appalachia--defined in this report as the Appalachian portions of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia--is an impoverished area that has been economically dependent on the coal industry for generations. Its schools face unique challenges in ensuring the college and career readiness of students, given that college had been neither needed nor desired in the past, and careers outside the coal industry are limited. Yet no review of education conditions and needs specific to the region has been conducted since 1983. This report responds to the need for such a synthesis, expressed by educators, policymakers, and other stakeholders to CNA Education in the course of more than a decade of work in Appalachia, including through Regional Educational Laboratory (REL) Appalachia. It is the product of a systematic review of published data and research about education in middle Appalachia from 1995 to 2015. Special attention is paid to issues that reflect national and regional priorities: college and career readiness, educator effectiveness, access to and quality of curriculum and instruction, systemic capacity, and health and wellness factors. The majority of the literature identified was small-scale qualitative research, such as case studies involving interviews. A common theme was the importance of Appalachian culture in education improvement initiatives--specifically, its attitudes toward education, attachment to family and place, commitment to the region, and responses to external mandates. Overall, the review suggests that education opportunities and outcomes in middle Appalachia are improving. Directions for future research that would build on past improvement efforts, analyze their long-term impact, and continue to investigate improvement initiatives are highlighted.