But on Monday, they were suddenly linked: Donald Trump, a real estate heir, tapped Middletown's most famous son, JD Vance, as his running mate.
Millions of people first learned of Middletown from Hillbilly Elegy, Vance's best-selling memoir and the Hollywood movie that followed.
Vance, 39, wrote about his chaotic upbringing there, raised in the intermittent care of a single mother struggling with addiction. In his depiction, Middletown was "little more than a relic of American industrial glory," a place "hemorrhaging jobs and hope."
His bleak portrait of the city just north of Cincinnati, was initially held up as reference guide for urbanites on the coasts desperate to understand Trump's appeal among the struggling white-working class.
Vance's explanation was a stark one: some of Middletown's woes were caused by the damaging decisions of government and big business, but the deeper problems lay in the fatalism, indolence and victim mentality of the city's white working class.
The problems in his community "run far deeper than macroeconomic trends and policy," Vance wrote in his book. "There is a lack of agency here -- a feeling that you have little control over your life and a willingness to blame everyone but yourself."
Middletown, which has begun to stabilize after decades of decline, was at its lowest point in the years that Vance chronicled. Some people in the nicer parts of town thought Vance had been unfair, said Jason Moore, 39, a truck driver who was a year behind Vance in high school. But he said, "people in this part of town would say he nailed it."
When Vance's grandparents moved to Middletown from eastern Kentucky in the 1940s, the city was in what most people say were its golden years. A half-dozen paper mills ran alongside the Armco steel mill, and the business owners lived in grand houses in town, bankrolling cultural festivals and a local symphony.
Most of the steelworkers -- a mix of first and second-generation European immigrants, Black families who had moved up from the Deep South and white families from Appalachia -- were represented by an independent and locally run union.
Middletown was, as Look Magazine declared in 1957, an "All-America City," and many of its residents thought of it that way.
Vance's grandfather, who worked at the mill, had been among those who found a foothold of economic security in Middletown, moving his family into a two-story house across from a neighborhood park. But that stability was fleeting. Vance's mother had a child as a teenager, divorced, remarried and in 1984, gave birth to Vance, just as the city's prosperity was beginning to founder.
In the late 1970s and early 1980s, the US steel industry collapsed across the Midwest. The Middletown steelworks were no exception. In 1985, Armco's corporate leadership decamped for the East Coast, draining the city of money, while the steel mill went through round after round of layoffs. Those who kept their jobs, some former employees said, found it an ever more miserable and more dangerous place to work.
Middletown struggled. Government-subsidized rentals began proliferating in the empty houses at a rate the city's social services were not equipped to handle. Shopping centers were boarded up and the city pools were filled with concrete. Many residents turned to drugs, including Vance's mother, who became addicted to narcotics. Her life became erratic as she cycled among boyfriends, and Vance sought refuge with "Mamaw," his hard-edge but protective grandmother.
This was the Middletown Vance knew in his childhood.
"That was how most of us lived," said Rodney Muterspaw, 55, who spent decades on the city's police force, five of them as chief.
Muterspaw went on to describe some of the larger context of the city's distress. He recalled with regret that law enforcement responded to the growing drug epidemic by focusing disproportionately on low-income neighborhoods. And he remembered being sent as a police officer to monitor locked-out workers picketing the steel mill, essentially ordered, he said, to spy on "our dads, our brothers, our uncles." Once an All-America city, Middletown appeared to have turned against itself.
Various attempts to lift the city's fortunes failed, reinforcing a pessimism among many residents. In his book, Vance mentioned that efforts to revive the downtown were "futile," a cynicism about government intentions that is far from rare.
"I've never seen a city that loves to hate itself as much as Middletown does," Muterspaw said.
Some of Vance's teachers did not recall any signs of Vance's struggles at home, though by high school, he wrote in his memoir, he had found some stability living with his grandmother.
At least one teacher remembered his growing political consciousness.
"His grasp and understanding of government and politics was extraordinary," said Mike Stratton, 79, who taught Vance's Advanced Placement English class at Middletown High.
When class discussion turned to politics, Stratton recalled, Vance was an outspoken Republican: supporting limited government and then-President George W. Bush. Vance's views were fairly standard Republican fare at the time, said Stratton, a Democrat.
"Middletown was a hotbed of conservative Republicanism back then, but JD Vance was a moderate," he said.
Stratton said that these days, Vance's political rhetoric, with its hard-right populism, seems quite different from what he heard in his classroom more than two decades ago.
Vance graduated from high school in 2003, when the city was still at its nadir, and joined the Marines. He built from there -- degrees from Ohio State and Yale Law School, a job at a Silicon Valley venture capital firm, election to the US Senate and now a place on a presidential ticket.
This rapid rise was fueled in large part by the success of "Hillbilly Elegy," which attributed his community's woes in large part on "a culture that increasingly encourages social decay instead of counteracting it."
Vance speaks differently now, blaming the ills of his community on immigration and elites, a far more populist tone.
Last year, after a freight train carrying hazardous chemicals derailed and burned in the industrial town of East Palestine, Ohio, Vance excoriated the "bicoastal elite," saying that they use places like East Palestine "for cheap propaganda," while reserving their sympathy for "Ukrainians, extreme sexual minorities, and criminals."
Elites, Vance said, ignored the fact that their prosperity was only possible because of "heartland labor, heartland sweat, and heartland peril."
That labor never stopped in Middletown, even in the grim years that Vance described in his book.
The steel mill's current owner, Cleveland-Cliffs, announced this spring that it was investing nearly $2 billion to upgrade the plant, with $500 million of that coming through a grant from the Biden administration. The plan was cheered by the local of the International Association of Machinists, the union that now represents workers at the mill.
Attempts to turn the city's fortunes around have continued, and some major projects have gotten underway, including Renaissance Pointe, described as a $200 million "epicenter" for stores, restaurants and hotels.
But reversing four decades of declining fortune is hard work. Downtown, there are brew pubs and a wine bar, but also plenty of empty storefronts.
Ami Vitori, 50, left Middletown after high school. But she came back in 2015, and in recent years has renovated an abandoned building downtown, attracting a restaurant, retail and even a boutique hotel. Vance praised her efforts in a 2017 New York Times opinion piece, which explained his decision to return to Ohio and open a nonprofit.
That nonprofit has since folded; Vance now lives in Cincinnati.
"Vance left Middletown behind a long time ago," Vitori said. To her, his interest in his hometown nowadays seemed limited to using it as symbol of what he has overcome.
George F. Lang, a Republican state senator who represents Middletown, pushed back on that notion. He pointed out that Vance had announced his 2022 run for Senate in the city and also opened his regional senate office there. "The most important thing he can do for Middletown," Lang said, "is be the example that he is."
Given Vance's ongoing rise to prominence, Vitori said she hoped for more.
"I honestly hope he's done what he's had to do to get where he is," she said. "And once he's there, he may actually try to do some good for people and places like Middletown."