The reasons are complex, and Elizabeth Drew in her NYRB piece about the election covers most of them, but I think it comes down to this part of her article where she quotes J.D. Vance:
In an important change from four years ago, only 26 percent of rural voters went for Clinton, in contrast with the 40 percent of them who supported Obama in 2012. Clinton came across to them as an creature from another, urban, world—a wealthy woman who liked big government and didn’t understand them. Her husband knew how to talk to them; he’d grown up around them and he spoke in their idiom. Jenna Johnson, who covered the election for The Washington Post, wrote that it’s not going too far to say that rural voters (presumably white ones) “hate” Hillary Clinton. J. D. Vance, author of the recent and New York Times best-seller Hillbilly Elegy, who grew up poor in Appalachia and went to Yale Law School, has become something of an oracle about the rural poor, a thoughtful one. He uses a critical word in describing how Trump wins the support of so many of his people: relatable. “People who are drawn to Trump are drawn to him because he’s a little outrageous, he’s a little relatable, and fundamentally he is angry and spiteful and critical of the things that people feel anger and spite toward,” Vance has said. “It’s people who are perceived to be powerful. It’s the Hillary Clintons of the world, the Barack Obamas of the world, the Wall Street executives of the world. There just isn’t anyone out there who will talk about the system like it’s completely rigged like Donald Trump does. It’s certainly not something you’re going to hear from Hillary Clinton.”
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