Worst ... The perception by many transplants and transplants-to-be that there are jobs aplenty here. Like most of the country, this is not "the Promised Land they spoke of". Jobs in once-more-abundant fields, such as manufacturing and technology, are very hard to get for most people, and if you lose yours, it can be extremely hard to get another one like them. Many once-proud-residents in this area have been forced to work in other states and leave their families here, and many have moved everyone entirely ... if they can get a sustainable price for their houses (assessed value, IMO). I should note that this is not an exclusive problem in our area .... just the
perception that this is not the case, thanks to certain media outlets.
While some people here imply that the housing market is better, I see only a minuscule uptick in my area. Still, I suppose "miniscule" is better than "none".
Summers. Long and hot. And yes ... buggy. Even with preventative measures and an exterminator program (most people in my area have one come by at least a couple of times a year ... usually more), you have a good chance of getting honking big roaches in your house. And unfortunately, several are not the harmless wood roaches. Oh, and then there there are those mosquitoes ... those can be wicked here.
I agree with those who list the scarcity of good ethnic food (if you're a transplant). HOWEVER, it is not bleak in this area. You just might have to travel a bit or search more thoroughly ... or learn to make your own.
Over-development in certain areas. Developers shoe-horned extra houses in areas where one or two really would have been more appropriate ... and left the mess for us. I remember when we moved here being amazed by the tiny backyards and very close proximity to other houses in many of the properties.
People asking "where are you from" constantly if you have a non-Southern accent, even if you've lived here for many years. I admit I might be sensitive to that, however. I came from a region where you constantly heard different accents, thought nothing of them, and certainly wouldn't have asked people that question. And you were "from" the area you where you now lived, even if your accent showed that you grew up elsewhere.
A shortage of good public transportation city-wide. If you live in the more densely-populated areas, this is less of a problem, but outside, it can be rough. There are many cities in the US that do have adequate transportation serving out-lying areas. Lack of good public transportation to many other cities in NC outside of RDU, though corridors such as Raleigh to Charlotte at least have trains.
Red clay soil ...everywhere!
People who do NOT know how to drive on roads with ice on them (worse here than in many areas), and lack of ice-sanding in many areas (though I guess that does preserve the road better, but ... ) The combo of clueless drivers, icy roads and hills can be treacherous, and yes, I try to avoid travelling under those circumstances whenever possible. But sometimes, it isn't possible.
Good points ...
Spring and Fall. Goodness, they can be beautiful here. And they don't last two weeks.
Lots of good areas to take long walks and enjoy the best of these two seasons. Plenty of opportunities to enrich both body and soul.
Learning that you can make better ethnic dishes that you thought you could, with a bit of trial and error.
If you need or prefer an apartment, this is a great place for you. There are many nice apartments in this area. Some areas of the country are not so apartment-friendly.
Personally, I like the trees. They give some refuge from the sun and heat in summer, and can attract some interesting birds. However, yes ... trimming or removing ones that are dangerously near the house is a great idea.
Milder winters. Enough snow to make that occasional snowman (in most years, anyway), but not so much that you're shoveling the stuff all season.
Good regional food, and farmers' markets to buy ingredients to prepare these dishes yourself, if you so choose.
Crape myrtles. Hardy and attractive.
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Just playing devil's advocate, I think the Census is wrong in splitting the metros, though the Raleigh-Durham thing has always been a huge pet peeve for me as well. Nobody says Grrensboro-High Point and they are in the same county.
I don't like the work raking and picking up branches and clearing gutters, etc. It's not specific to NC for me. We lived under a HUGE oak in the Philly area and had branches falling and damaging the roof constantly. 
