In Eastern Kentucky, a grim tale unfolds. Ruth Blue is a young woman, abandoned by her mother at childhood. She lives with her father, Tobias, a would-be preacher with a vicious personal life as a gambler and alcoholic. Earl, her husband, gave up his beautiful dreams to be a coal-miner. Both use her as a slave, sending her around on little errands and chores.
One day, Ruth has a baby boy and names him Andrew. She feels as though she has fulfilled her God-given destiny to bring life into the world. Then, as so often happens in Kentucky coal mining communities, the coal mine dries up, leaving the town without income. Ruth finds work as a maid and becomes obsessive about her religion, often using her religion to repress her son, who grows up gay.
Andrew is 30 in present time. One day, after a date with his boyfriend, while he's asleep in bed, his mother hands him the family gun and tells him to "choose his destiny." The implication is that Ruth herself has abandoned hope for life.
