Alternative country artist Steve Earle played a street musician on HBO's New Orleans-based show Treme, which is set in the aftermath of the 2005 floods that caused devastating damage in the Louisiana city. During the filming of the second season, a drilling rig exploded in the Gulf Mexico causing the largest accidental marine oil spill in the history of the petroleum industry. The spill caused extensive damage to marine and wildlife habitats as well as the Gulf's fishing and tourism industries. This ballad was inspired by the incident.
Earle recalled to Spinner: "We were at the end of the season, we were all feeling pretty good, and pretty good about ourselves. We were all patting ourselves on the back because the locals seemed to like the show and we liked the show, we liked what we had been working on.Then at the very end of it, when we were filming episode eight or nine, the spill happens. You could watch folks that lived here that were really starting to feel good about themselves and about the city, and it put this big huge question mark about 'What's going to happen to us now? What more can happen?'"
Earle said that the song came from a place of both solidarity and anger. He told Spinner: "People around here want the drilling again to start immediately, and it's sort of telling the story of people that are dependent in it. I believe that they're being had, that they're being lied to, but I do understand. It's about the hope that those people might get jobs, and they just don't want that hope taken out of their lives."
I'll Never Get Out Of This World Alive takes its name from Hank Williams' posthumous 1953 hit - it was the last tune the country legend recorded before he died. Earle's debut novel also uses the same title.