In Laurelville, Ohio—a small town in the foothills of the Appalachians—nobody knows why Hannah Marshal drowned in Laurel Creek in 1937. But twenty-three years later, her niece, Ruth Sherman, takes it upon herself to find out. With only a few rumors, old newspapers clipping and even some ghost stories about her aunt, Ruth begins to uncover the events surrounding Hannah’s death. Ruth dismisses the ghost stories, but she knows all about being haunted by Hannah Marshal. Born eighteen months after Hannah’s death, Ruth grows up feeling she is Hannah’s replacement. Every major event of her life is heavy with her aunt’s memory. Ruth hears that she looks like Hannah, acts like Hannah, and many people even call her Hannah. Ruth is a walking reminder of her aunt, a living ghost of a person dead more than a year before her own birth. During the summer of 1960, when Ruth is twenty-one years old, she is pressed by her grandmother to learn the folk cures and healing rituals of Appalachian Christianity. Certain that she is finally being compelled to replace her Aunt Hannah, Ruth decides to discover once and for all the truth around Hannah Marshal’s death. Ruth finds herself on a journey into the past, the traditions of a southern-Ohio Pentecostal church, and the shadowy side of the Holy Ghost among serpent handlers. On the journey, Ruth discovers her own spiritual gifts and uncovers the unspoken shame in her family.