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Mortality rates among working-age adults differ markedly between counties. These differences have been growing unabated for several decades as some counties experienced impressive declines in mortality rise, others experienced worrisome increases, and some experienced little change. Why have county mortality rates become so different? Can anything be done to stem or reverse the growing differences? This presentation will share new insights into these questions. Examining a large number of county characteristics in addition to state policies, it uses machine learning approaches to identify which combination of those factors predict working-age mortality rates over a 30-year period. Using counterfactual analyses, it then identifies which factors contributed the most to the growing differences in mortality rates across counties since 1990.