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The Twin Tiers are the collective counties that lie on the New York-Pennsylvania border on either side of the 42nd parallel north. The region is predominantly rural and contains many small towns.
Separately, the two halves of the Twin Tiers region are known as the Southern Tier region in the state of New York and the Northern Tier region in the Commonwealth of Pennsylvania. The "Northern" and "Southern" designations are relative to the states in which they are located, not relative to each other.