This project investigates the use and meaning of harsh voice quality (HVQ) in Appalachia. HVQ is a rough, growling phonation type with a higher degree of shimmer and jitter and a lower harmonics-to-noise ratio compared to modal voice (Moisik 2013). This paper examines the acoustic measurements and context of HVQ in white male participants from Southeast Ohio, the North Central region of Appalachia (Appalachian Regional Commission 2021). Many of the participants’ harsh utterances were produced in instances of speech cooccurring with embodied action (Pratt and D’Onofrio 2017), such as movement and laughter. However, they also utilized HVQ in performing or parodying Appalachian identity, through voicing another Appalachian man or embodying a stereotype. Additionally, the participants associated HVQ with Logan County, West Virginia, as well as with Appalachian stereotypes, such as coal mining and rurality. Thus, this project contributes to the growing body of sociophonetic work on non-modal phonations and emphasizes the need to examine indexicality through a regional lens.