Maj. Joshua Metzger, optometrist, 127th Medical Group, Selfridge Air National Guard Base, Mich., examines a patient during Innovative Readiness Training Appalachian Care 2019 at Wise County Fairgrounds, Wise, Va., Aug. 18, 2019. Appalachian Care Innovative Readiness Training 2019 takes place Aug. 16-29, 2019, to care for the medically underserved communities of Wise, Virginia while simultaneously conducting deployment and readiness training for military personnel. Innovative Readiness Training is the only hands-on training opportunity authorized to operate within the U.S. During Appalachian Care IRT 2019, medical operations will be staged at one physical location at Wise County Fairgrounds. The Appalachian Care IRT 2019 team provides medical, dental, optometry and veterinary care to assist local health and municipal authorities in addressing underserved and unmet community health and civic needs. Units also conduct critical mission training and logistical movement in order to simulate hands-on deployment readiness operations and health care delivery in the time of crisis, conflict or disaster. (Air National Guard photo by 1st Lt. Andrew Layton)