Background Prior mortality estimates of air pollution from coal-fired power plants in India use PM2.5 exposure-response functions from settings that may not be representative, and do not include other potentially harmful effects of these plants, such as fly ash pollution and heavy freshwater consumption. Methods We use a national, district level dataset to assess the impact of coal-fired power plants on all-cause mortality (15-69 years) in 2014. We compare districts with coal-fired power plants (total capacity >1000 MW) to districts without a coal-fired power plant, estimating the effect of these power plants on all-cause mortality within districts that have these plants. Results Out of 597 districts in India in 2014, 60 districts had a coal-fired power plant. When compared to districts without a coal-fired power plant, districts with a coal-fired power plant (>1000 MW) had higher rates of age-standardized mortality in both women (0.38, 95% CI: -0.14 - 0.90) and men (0.55, -0.17 - 1.27). Similarly, these districts had higher rates of conditional probability of premature death in both women (2.22, -0.13 - 4.56) and men (2.12, -0.54 - 4.77). The point estimates for total excess deaths were 19,320 for women and 27,727 for men. In affected districts, the proportion of premature adult deaths attributable to coal-fired power plants was 5.8% (-0.3% – 11.9%) in women and 4.3% (-1.1% – 9.6%) in men. Conclusions We estimate that ~47,000 premature adult deaths can be attributed to large coal-fired power plants in India in 2014. These deaths are concentrated in the ~10% of districts that have the nation’s power plants, where they are associated with 1 out of 20 premature adult deaths. Effective regulation of emissions from these plants, coupled with a phaseout of coal-fired power plants, can help decrease this burden of inequitable and premature adult mortality.