Publisher Summary This chapter deals with the effect of coal usage on human health and the environment. Coal has played a significant role in the advancement of civilization and continues to be a major fuel source for at least the next quarter century. Coal mining has a direct impact on the environment, as it disturbs large areas of land and has the potential to affect surface water and groundwater in the case of surface mining. In some surface mines, the generation of acid mine drainage (AMD) is a major problem. Other significant impacts include fugitive dust emissions and disposal of overburden and waste rock. This chapter focuses on coal utilization, specifically combustion, which produces several types of emissions that adversely affect the environment, particularly ground level air quality. In addition, the generation of coal combustion by-products must be addressed, whether they are disposed of or reused. Moreover, this chapter discusses the environmental and health effects of these pollutants, along with other pollutants, such as carbon monoxide (CO), lead, and organic emissions. This chapter concludes that the impacts of mining, storage, handling, transportation, beneficiation, combustion by-products, and emissions from coal-fired power plants are presented with a focus on activities in the United States.