The Presbyterian Church (United States of America) is the largest Presbyterian denomination in the United States. The Presbytery of West Virginia’s website says that there are some 140 congregations “tucked among the forested mountains, nestled in the river valleys, found in coal mining camps and villages.” The vast majority of these churches are very small and cannot support qualified pastors. I think it is safe to say that, in spite of the large number of churches, the denomination is struggling in West Virginia.
The PC(USA) is a mixed bag of liberal, moderate, and relatively conservative congregations throughout the nation, although I would guess that the conservatives are in a small minority. I do not know what the spread on the spectrum is like in West Virginia, but I would expect it to be similar to that of the rest of the nation, if not a smidge more conservative. During my time at Pittsburgh Theological Seminary, a prominent and well-respected PC(USA) seminary, I have encountered several pastors and faculty who are on the more conservative end of the PC(USA) spectrum. Even the most conservative of these, however, are still far left of the most “unconservative” within my own denomination. Regardless, with so many PC(USA) churches throughout the State of West Virginia, one would like to think that Reformed theology would not be so foreign and irrelevant to West Virginians. But it seems that the presence of so many churches has had little-to-no lasting impact on West Virginians' understanding of and commitment to Reformed theology. I think this is because the PC(USA) long ago left off really preaching the Word of God and the Gospel that it contains.
My own denomination, the Presbyterian Church in America (PCA), is the second largest Presbyterian denomination in America, but it is growing faster than the PC(USA). However, our ten-congregation presence in West Virginia is still very meager. We are also struggling in this State. This is not for lack of preaching the Word of God, but possibly due in part to some cultural elements unique to West Virginia. Regardless, the longer-term presence of the PC(USA) has not laid any doctrinal foundation whatsoever within our State upon which the PCA can build. The PCA is starting from scratch with regard to the form and faith of Presbyterianism in West Virginia. We have to take back a lot of theological ground that was long ago evacuated by the PC(USA).