Gov. Earl Ray Tomblin's appointment of Karen Bowling as the new head of the state Department of Health and Human Resources will surely spark controversy over her salary.
Taxpayers will pay her $175,000 a year - 84 percent more than the man she succeeds. Rocco Fucillo was paid $95,000 a year in that post.
But Bowling's salary reflects the scope of the job. The DHHR now spends more than $4.3 billion a year and employs more than 6,000 people.
More than half of that money is in Medicaid payments disbursed to hospitals and other health providers for the care of the poor, the old and the disabled. Under Obamacare, that spending will expand next year.
The agency also handles welfare, food stamps and other relief programs, as well as public health.
That is an enormous undertaking and responsibility. Indeed, DHHR's budget is larger than the $3.2 billion a year West Virginians spend on public schools.
The management of such an agency requires skills and experience that cost money.
Bowling's resume is extensive. A nurse practitioner, she also spent eight years as CEO of Raleigh General Hospital in Beckley. She is also a former chairwoman of the West Virginia Hospital Association.
The salary reflects in part the size of the job. She is taking on a tough challenge, and here's hoping she's up to the task.