This op-ed was originally published in the Bristol Herald Courier.

A disturbing truth was revealed in the ongoing spat between Sen. John McCain and President Donald Trump. That is: Most people who fight and die in American wars come from the working class.

McCain, widely seen as criticizing Trump’s multiple deferments from fighting in the Vietnam War, highlighted this fact of class inequality recently when he was being interviewed for a C-SPAN3 show, “American History TV.” The topic was the Vietnam War. McCain said:

“One aspect of the conflict, by the way, that I will never ever countenance is that we drafted the lowest income level of America, and the highest income level found a doctor that would say they had a bone spur. … That is wrong. That is wrong. If we are going to ask every American to serve, every American should serve.”

Working-class people of America, and Appalachia in particular, have long been the backbone of U.S. military engagements abroad. They bear much of the direct, physical, psychological and emotional costs of American war-making.

My Uncle Jack is a classic example of a working-class Appalachian who fought in one of America’s wars. He was born in 1948 and raised a few miles outside Damascus, Virginia. As a U.S. Army combat infantryman, he fought and died in Vietnam in 1967.

Research shows that the Vietnam War was primarily a working-class war. Most sons of upper-income Americans were not combat soldiers in Southeast Asia. In fact, upper-income Americans during the Vietnam War, like Donald Trump and Dick Cheney, were much more likely to receive deferments for college or for medical reasons.

In a 1987 interview, Dr. Steven Giles, then chief of Psychology Services of the Veterans Administration Medical Center at Mountain Home in Johnson City, made the point clearly. Giles said that a disproportionate number of soldiers from Appalachia were killed or suffered trauma-related combat stress disorders because so many men from Appalachia were sent to fight.

Today, the draft is no longer in effect; women are able to serve in combat roles; U.S. soldiers are more educated than their civilian peers; and the U.S. military is generally very diverse when compared with the Vietnam era. Yet the men and women who fight America’s wars today are not that different from then.

The working class still carries the burden for American wars. Michael Zweig, professor of economics and director of the Center for Study of Working Class Life at the State University of New York at Stony Brook, conducted a study of the nearly 1,800 combat deaths in Afghanistan from 2001-2010. Zweig shows that while 62 percent of Americans are working class, 78 percent of the war casualties have come from working-class families. Overwhelmingly, those who fought and died in Afghanistan were working-class Americans.

The story is the same for the war in Iraq. By late 2005, nearly 2,000 U.S. soldiers had been killed there. The fatalities were disproportionately white, working-class young men from the American South.

Indeed, the top 20 U.S. counties for Army recruitment have median incomes that are lower than the national average, with 12 of those counties having some of the highest poverty rates in the country.

Martinsville, Virginia, stands out as a prime example. In proportion to the youth population, Martinsville had the greatest number of working-class enlistees compared with any other location in the U.S.

The main reason that working class youth from Appalachia and the South are over-represented in war fatalities has to do with economics. Poor and working class young men and women flee economically depressed areas and dead-end jobs in what critics like Joe Bageant call “economic conscription.” With no real prospects, a modest $1,300 per month salary, along with free room and board, skills and training, and the prospects of money for college make the U.S. military seem like a better future than one at home.

The men and woman of Congress who authorize war are much less likely to have served in the military and are much more likely to come from upper-income families.

The issue of working-class Appalachians and Americans carrying the burden of U.S. war-making is an important matter to consider, especially in light of the saber rattling with North Korea.

The young men and women who will do the vast majority of fighting, suffering, and dying in far-off lands for these upper-income policymakers will be our working-class youth.

Jacob L. Stump is an author, professor and small business owner from Konnarock in Southwest Virginia.