Due to a shift in market demand, and the development of technology to access the Marcellus Shale formation, a massive natural gas boom has swept through rural communities in the northern part of West Virginia. Much like the massive infrastructure built to support the coal industry, large new infrastructure systems are being built to produce and transport natural gas acquired through fracking. In the Hills and Hollows investigates the boom and bust impacts that mono-economies based on fossil fuel extraction have on local communities. It provides an intimate look inside the lives of several West Virginia residents living in the middle of the boom and how their quality and way of life is forever changed by this industry. The film also explores the lives of residents who have left their home and the place they love, as a result of the growth and development of the fracking industry.