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Is Ohio in the midst of a rust belt rebound?

I WENT BACK TO OHIO
BUT MY CITY WAS GONE
THERE WAS NO TRAIN STATION
THERE WAS NO DOWNTOWN
—The Pretenders, "My City was Gone"

In her classic 1982 song about her hometown, singer-songwriter Chrissie Hynde of The Pretenders mourns the changes in Akron, Ohio—once a gritty but picturesque manufacturing town, sliced up in the 1960s and '70s by shopping malls and urban renewal.

Akron is hardly alone. In the heart of the region that became known as the Rust Belt, city after city in Ohio has felt the impact of the long, painful decline in U.S. manufacturing. But like the Ohio State Buckeyes, who have managed to claw their way into the 2015 college football playoffs even after losing their top two quarterbacks to injury, the state is finding new ways to compete—and is fine- tuning old ones.

The Cleveland Clinic
Ron Antonelli | Bloomberg | Getty Images

Ohio has begun to reverse the long economic slide that worsened following the 2008 economic crisis. The state's GDP, which tops $529.4 billion, grew 1.8 percent last year, at the same rate as the U.S. economy. Jobs are returning to cities such as Akron, Youngstown and Cleveland. But the makeup of the Ohio economy is much different than it once was, and it is unclear whether the state's new business model is any more sustainable than the old one. That is critical, because Ohio has still recovered only a fraction of the jobs it lost during the Great Recession, when unemployment stood at 10 percent or higher for more than a year.

Today, the unemployment rate is a mere 5.3 percent—below the national average—in part because of growth in nonmanufacturing industries such as health care. But manufacturing is resurgent, as well, as Ohio retools to support a domestic energy boom.

Despite the dramatic improvement in Ohio's unemployment rate, the state's recovery has far to go. The state has regained only about half of the more than 400,000 jobs it lost in the recession, while many other states, and the nation as a whole, have recovered all the lost jobs and then some.

And Ohio's new economy is already showing signs of strain.

Take health care, which is powering job growth in and around Cleveland, where some 700 biomedical firms—including Philips Healthcare, Steris and Invacare— have sprung up and flourished around the world-renowned Cleveland Clinic. According to the U.S. Bureau of Labor Statistics, metropolitan Cleveland added an average of 3,250 health-care jobs per year between 2004 and 2012. But the area added fewer than 2,000 jobs last year, and job growth this year is nearly flat.

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Heading into 2014, the Cleveland Clinic announced some $330 million in budget cuts and warned of the first layoffs in more than a decade. Officials cited the Affordable Care Act as one of the reasons for a sweeping restructuring.

"To prepare for health-care reform, Cleveland Clinic is transforming the way care is delivered to patients," officials said in a statement in 2013.

Some 700 of the facility's 42,000 employees accepted early retirement packages in what "Becker's Hospital Review" listed as the largest hospital-related job reduction in the nation this year. Other health-care companies in the region followed suit.

A change in control of Congress as well as legal challenges to the ACA in 2015 could add even more uncertainty to Ohio's health-care economy—uncertainty that is spreading to other Rust Belt cities such as Pittsburgh and Buffalo, N.Y., that also have been turning to health care as an economic engine.

That brings Ohio back to its manufacturing heritage, a sector that had finally been showing some glimmers of hope after years of decline. But it, too, faces serious challenges.

Once upon a time, Youngstown was America's third-largest steel producer, with a peak population of 170,000. But when the city's main employer, Youngstown Sheet and Tube, shut down in 1977, Youngstown's population fell by half, and the area never fully recovered. Oil and natural gas exploration in the nearby Marcellus and Utica Shales has begun to change Youngstown's fortunes. That's because fracking requires steel tubing, and steel is in Youngstown's DNA.

Read MoreHow Youngstown, Ohio, became a poster child for post-industrial America

Unemployment in the city has plunged from a prerecession high of 12.7 percent to 5.5 percent today. Some are finding work in the oil fields and in related construction. Manufacturing jobs are holding steady—something Youngstown had not been able to say until recently—and a French steel tubing manufacturer, Vallourec Star, recently spent $1.1 billion on a new manufacturing facility. A sister company, VAM USA, is spending another $86 million to expand its pipe threading operations.

But something else has been plunging along with Ohio's jobless rate: the price of oil. That is changing the economics of fracking practically on a daily basis, particularly in higher-cost areas like Ohio and Pennsylvania. While analysts have previously said that shale oil and natural gas could add millions of jobs to the U.S. economy, most of those predictions were made when the profit potential was higher.

As for Akron, the city that Chrissie Hynde sang of as "gone" 30 years ago has definitely returned. Once known as the tire and rubber capital of the world and home to Goodyear Tire & Rubber Co., it has added polymers, information technology and biomedical engineering to its business portfolio. Unemployment is a mere 4.8 percent.

Read MoreManufacturing in Ohio seeing a slow, steady growth

But like the state of Ohio and the rest of the Rust Belt, it is still unclear whether the current boom will end the same way the last one did.

This week, CNBC is looking in-depth at Ohio, and whether talk of a Rust Belt Rebound is for real. We will have special reports on CNBC and CNBC.com.

Correction: An earlier version incorrectly reported the status of the Vallourec Star plant in Youngstown.