In Southern and Appalachian speech, "ails" means to trouble, bother, or cause pain. Often heard in the question "What ails you?" it’s an old English word that has lingered in rural American dialect.
I do hear 'ails' from time to time, but I'd say it's a country one, mainly old timers.
Hillbilly Dude Says...
I do hear 'ails' from time to time, but I'd say it's a country one, mainly old timers.
Pronunciation
[AYLZ] /eɪlz/
Meaning & Usage
- To trouble, bother, or cause pain (verb)
Everyday use
Clara:
He’s been sittin’ quiet all evening.
Elmer:
Don’t know what ails him.
★ If somebody tells you it'll 'cure what ails ya,' don't get it too close to fire. ★
Origin and Etymology
From Middle English ailen (to trouble, afflict), with roots in Old Norse eila. In general English it became less common, but in Southern and Appalachian dialects, forms like "What ails you?" survived as everyday speech.
Usage Notes
What ails you? is one of the most common expressions, still familiar in rural Southern/Appalachian communities.
Outside these regions, the word sounds old-fashioned or literary.
Can describe physical illness ("My back ails me") or emotional/spiritual trouble ("Something ails his spirit").
Yes - especially in the South and Appalachia, where "What ails you?" is still a common phrase.
Is it only Southern?
No. It’s an older English word, but it’s been preserved in Southern/Appalachian everyday talk long after falling out of common national use.
How to Cite This Page
APA (7th edition)
The Hillbilly Dude. (2025, October 17). Ails. HillbillySlang.com. https://www.hillbillyslang.com/definitions/ails
MLA (9th edition)
"The Hillbilly Dude." "Ails." HillbillySlang.com, 17 Oct. 2025, https://www.hillbillyslang.com/definitions/ails.
Chicago (17th edition)
The Hillbilly Dude. "Ails." HillbillySlang.com. October 17, 2025. https://www.hillbillyslang.com/definitions/ails.
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Created by a true, actual, proper, real-life hillbilly, HillbillySlang is a growing field guide to culture, speech, memory, and meaning - rooted in Appalachia but reaching across the world. Every slang word, saying, accent and story is gathered from first-hand experience and trusted sources. The goal: preserve authentic voices and share them with writers, learners, and culture lovers everywhere - with a little humor thrown in here and there. Read more...
I do hear 'ails' from time to time, but I'd say it's a country one, mainly old timers.