The paper examines the impact of medieval mining upon the environment, based upon the present state of the historiographical, archaeological, and geological research. By the middle of the 13th century a massive increase in the exploitation of precious metals is noted, inducing the appearance of settlements in the vicinity of the locations of extraction and production of ores. The problems of water and air pollution occurred, raised by the operation of smelteries inside these settlements or in their immediate vicinity. Although the presence of slag indicates certain metallurgical activity, it is hard to discern the precise purpose and the period of their activity without archaeological excavations. The increase in demand for fuel may have induced deforestation, so the rights to exploit forests were legally regulated. The scope of wood exploitation in the region of Šumadija has been judged by the research estimating the presence of potassium in the previously registered old slag deposits. It is hard to discern the general health status of the inhabitants of the mining regions, since a small portion of skeletal material is examined, not including the one from the most important mining center of Novo Brdo. The anthropological analysis indicates the problems caused by hard physical activity and poor hygiene. The present knowledge on the influence of heavy metals indicates the impact of past mining practices upon the environment and human health. Decomposition of sulphides in the discard deposits and old slag, as well as the leak of acid waters from old shafts, still affect the present pollution of water and soil in the vicinity of mining centres such as Rudnik and Srebrenica. These same reasons may have presented dangers for the population living there during the period of 15th to 17th century. The future archaeological research, with the inclusion of other disciplines, will bring more detailed understanding of the relationship between people and their environment in the mining regions of the Medieval Serbia.