So hard that the plaintive sound of a local musician drawing a knife blade across the strings of his guitar gave birth to the blues here a century ago. So hard that a Roman Catholic nun named Anne Brooks has struggled for the last 27 years to keep a medical clinic open for the poor.
She sees the nation's new healthcare law as a potentially happy turn in a long, hard journey. The measure provides hundreds of billions of dollars to help states expand medical insurance for the poor and pay doctors like Brooks, nearly half of whose patients have no coverage.
But there's a good chance this story will end with another difficult twist in the road for Brooks and for Tutwiler.
Mississippi has the highest poverty rate in the nation and some of the sickest people, with the country's highest rate of heart disease and the second-highest rate of diabetes.
For every dollar the state spends to expand healthcare for the poor, it stands to get as much as $20 from Washington. But state officials have been making it harder, not easier, to enroll in government-backed healthcare programs.
Republican Gov. Haley Barbour campaigned on a promise to cut the healthcare safety net to balance the state budget. Shortly afterward, Mississippi began requiring Medicaid recipients to submit to in-person interviews once a year, making it the only state with such sweeping a rule. In Tutwiler, the closest registration office is in nearby Sumner. It's open one day a week, on Tuesdays, from 9 a.m. to noon and 1 p.m. to 3 p.m., as well as the third Wednesday of month.
Barbour, who said recently that the healthcare overhaul "would prove disastrous" for Mississippi, has joined a lawsuit filed by GOP officials in several states seeking to overturn the law. For the little clinic near the banks of Hobson Bayou, that could mean more challenging days ahead.
Built before desegregation, the Tutwiler Clinic had separate waiting rooms for black and white patients when Brooks took it over in 1983. Many still remember the September day in 1955 when an all-white jury at the county courthouse in Sumner acquitted two white men for killing a 14-year-old black boy named Emmett Till and dumping his body in the nearby Tallahatchie River because he whistled at a white woman.
Brooks was fresh out of osteopathic school when she got here. She had sent letters offering her medical services to mayors up and down the Mississippi Delta. Tutwiler was the only place that answered.
"Catholics are terrible about quoting things," she said. "But there is a place in the gospel of Matthew where it says something like, 'Freely you have received, freely give.'"
For herself, Brooks said, "I have received so much."
It wasn't always clear that would be true.
The only child of a Navy captain and an alcoholic mother, Brooks didn't have much of a family life growing up in the 1940s in Washington, D.C. When she was in sixth grade, her parents divorced and her father sent her to a Catholic boarding school in Key West, Fla.
In her teens, Brooks was stricken with rheumatoid arthritis and confined to a wheelchair. Protected by the sisters who taught at the school, Brooks decided she too would become a nun.
Then, in 1972, Brooks met a doctor at a free clinic in Clearwater, Fla., who changed her life, treating her with a mix of acupuncture, dietary changes and psychotherapy. Within six months, Brooks was walking again.
Six years later, Brooks once more heeded her doctor's advice. With permission from her Catholic order, she enrolled at Michigan State University's College of Osteopathic Medicine. "I never thought I would be a doctor," she said. "I couldn't even pass chemistry."
But become a doctor she did, and she soon found herself with the keys to a dilapidated one-story brick building just off Tutwiler's derelict main street.