MORRISTOWN, Tenn. — The Hamblen County Jail has been described as a dangerously overcrowded “cesspool of a dungeon,” with inmates sleeping on mats in the hallways, lawyers forced to meet their clients in a supply closet and the people inside subjected to “horrible conditions” every day.

And that’s the county sheriff talking.

Jail populations used to be concentrated in big cities. But since 2013, the number of people locked up in rural, conservative counties such as Hamblen has skyrocketed, driven by the nation’s drug crisis.

Like a lot of Appalachia, Morristown, Tenn., about an hour east of Knoxville, has been devastated by methamphetamine and opioid use. Residents who commit crimes to support their addiction pack the 255-bed jail, which had 439 inmates at the end of October, according to the latest state data.

Many cities have invested in treatment options and diversion programs to help drug users. But those alternatives aren’t available in a lot of small towns.

“In the big city, you get a ticket and a trip to the clinic,” said Jacob Kang-Brown, a senior research associate at the Vera Institute of Justice, which released a report on Friday analyzing jail populations. “But in a smaller area, you might get three months in jail.”

The disparity has meant that while jail populations have dropped 18 percent in urban areas since 2013, they have climbed 27 percent in rural areas during that same period, according to estimates in the report from Vera, a nonprofit group that works to improve justice systems. The estimates are drawn from a sample of data from about 850 counties across the country.

There are now about 167,000 inmates in urban jails and 184,000 in rural ones, Vera said. Suburban jail populations have remained about the same since 2013, while small and midsize cities saw a 7 percent increase.

Rural jails now lock up people at a rate more than double that of urban areas. And increasingly, those inmates are women. Hamblen County officials said the number of female inmates in their jail has doubled in the past decade.

Drug use isn’t the only reason that some rural jails are packed. State prisons sometimes pay counties with extra bed space to house inmates, and so does the federal government. The number of Immigration and Customs Enforcement detainees held in jails rose by about 4,300 from 2013 to 2017, Vera estimates.

Small towns also lag cities in efforts to reduce incarceration, such as releasing nonviolent offenders without requiring them to pay hefty bail amounts while awaiting their day in court.

The rural jail boom runs counter to a nationwide, largely bipartisan push toward reducing incarceration, which has been embraced by everyone from the American Civil Liberties Union to President Trump’s son-in-law, Jared Kushner. Sentencing law revisions have led state and federal prison populations to drop since 2009, following a four-decade boom.

Many cities have seen the number of people in jails, which hold people convicted of minor crimes or awaiting trial, plummet in similar fashion. In Nashville, 200 miles west of Morristown, the inmate population has fallen 28 percent since 2013, according to Vera. Other cities with big declines include Buffalo, Chicago, New York City, Oakland and Philadelphia.

But in places like Hamblen County, with a population of 65,000, the system works differently. People get arrested on charges like possession, shoplifting to pay for their addiction or failing a drug test while on probation, and bail is set too high for many to afford.

Almost everyone in the county jail is there because of charges related to addiction, said the sheriff, Esco Jarnagin.

Inside, many lose jobs and are further cut off from family and friends. The odds of getting back on track on the outside dwindle, and the cycle repeats.

Few know more about this cycle than Kim Coffey, who has worked in many aspects of Hamblen County’s criminal justice system — for a defense lawyer, as a bail bondswoman and as a juvenile drug addiction counselor.

Now she is one of the sheriff’s jailers. At work, she often sees her daughter, who has spent much of the last decade in and out of jail after getting hooked on pain pills following an injury.

“They were giving her hydros like they were Tic Tacs,” Ms. Coffey said, referring to hydrocodone, a powerful opioid that her 29-year-old daughter took for more than a year. “Then they cut her off cold turkey. Her back was still in pain, and she did what she felt she had to do. You go to the next available thing. Now, it’s meth.”

Given the lack of options, Ms. Coffey said jail was sometimes the best place for her daughter. “At least when she’s here, I know she’s alive. I know she’s not in a ditch somewhere.”

Yet she wishes the county had more treatment options and job-training programs that could help inmates like her daughter. “If we could help people to finds jobs, then they wouldn’t go back to drugs, because otherwise you go back to what you know to make a living.”

As she spoke, another guard shouted, “Hey, we got a fight!” Ms. Coffey rushed off to help break up a brawl between female inmates, who now account for a third of the jail’s population.

Fights in the jail are a common occurrence, said a former sheriff’s deputy who is now serving time himself; he said he stole a commercial lawn mower after getting hooked on pain pills following shoulder surgery.

“Tensions run high when you got 60 people in a 20-man pod,” said the former deputy, who asked that his name not be used because he feared he could face retaliation.

One recent six-month stretch had more than 150 inmate-on-inmate assaults, according to a judge’s findings in an ongoing federal lawsuit, which also said the jail suffered from “overcrowding, insufficient security checks, inadequate staffing, difficulty with properly classifying inmates, failure to provide information about reporting sexual assault to inmates, and many incidents of inmate-on-inmate assault.”

Hamblen County officials have proposed a new justice center that would include a jail twice the size of the current one, as well as new courtrooms. But the $73 million price tag has drawn protests from some taxpayers.

Over the past six years, the county’s annual jail expenses have risen to $4.4 million from $2.6 million, said Bill Brittain, the county’s top administrator.

Defense lawyers have proposed other options to address the crisis, including a pilot program for pretrial supervision similar to one in nearby Knoxville and other cities. It would have allowed some low-risk defendants to avoid having to post bail, and to avoid jail even if convicted.

But judges rejected the proposal because of fears that defendants would flee, said Willie Santana, a former prosecutor in Knoxville who is now one of four lawyers in the Hamblen County public defender’s office. “The whole system is geared toward generating pleas and putting people in jail,” he said.

For many inmates, that means the jail has been a revolving door. More than three-quarters of the 850 new cases that Mr. Santana handled in the past year involved a client who had previously been incarcerated for something drug-related, he said.

Many small cities and rural areas haven’t embraced efforts to make it easier for nonviolent offenders to get on with their lives after scrapes with the law. And even in rural areas that might favor more treatment over incarceration, hospitals have shut down, limiting their choices.

“You don’t have any treatment options, or at least it seems to them that they don’t, so many judges and prosecutors feel that they have no choice but to lock people up,” said Pamela Metzger, director of the Deason Criminal Justice Reform Center at SMU Dedman School of Law.

Despite the overcrowding in Hamblen County, the sheriff and some other officials are skeptical that big-city solutions could work here. Sheriff Jarnagin said he favors education and prevention over treatment.

“We can’t cure them once they get on some of these drugs,” he said. “It’s jail, or the graveyard.”

Pretrial diversion, he added, would reduce jail numbers, but would also mean criminals running loose. “They’re going to commit a crime and be right back in here on something else.”

One ray of hope has been a jail-to-work program for female inmates, administered by a local treatment facility. It takes just eight women at a time, but of its 45 graduates over the past two years, only seven have committed new crimes, Mr. Brittain said.

Buoyed by the program’s success, he wants to start a similar one for men. Treatment would be a better option for most inmates at the jail, he said.

“East Tennessee is a very conservative area, and folks believe that people who commit the crime need to do the time, but that’s costing the local government tremendous money to do that,” Mr. Brittain said. “We can’t build our way out of jail overcrowding. We’ve got to change some of the ways we detain and punish people. We’ve got to do something different.”

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