I thought the movie was true to the book. As the daughter of Kentucky born parents, who, also moved to southern Ohio much of this rang true to my experiences. While my parents were "city" people (Lexington KY) and were college educated, Kentucky was always "home". The family ties are unbeatable.
I have extended family in Middletown. There are second and third generations of people who moved north for steel mill jobs and once the jobs left they were left with no anchor to their lives. It continues to be an area hard hit with unemployment and drug abuse.
Ron Howard did a great job integrating the back story, I had wondered how it would all fit together. Amy Adams and Glen Close were excellent as well as the supporting fast (sorry I don't remember names!) Including both JD's.