This paper reports the effect of chimneys in reducing indoor air pollution in a lung cancer epidemic area of rural China. Household indoor air pollution concentrations were measured during unvented burning (chimneys blocked) and vented burning (chimneys open) of bituminous coal in Xuan Wei, China. Concentrations of particulate matter with an aerodynamic diameter of 10 μm or less (PM10) and of benzo[a]pyrene (BaP) were measured in 43 homes during normal activities. The use of chimneys led to significant decreases in indoor air concentrations of particulate matter with an aerodynamic diameter of 10 μm or less (PM10) by 66% and of benzo[a]pyrene (BaP) by 84%. The average BaP content of PM10 also decreased by 55% with the installation of a chimney. The reduction of indoor pollution levels by the installation of a chimney supports the epidemiology findings on the health benefits of stove improvement. However, even in the presence of a chimney, the indoor air concentrations for both PM10 and BaP still exceeded the indoor air quality standards of China. Movement up the energy ladder to cleaner liquid or gaseous fuels is probably the only sustainable indoor air pollution control measure.