Production of geothermal energy for electricity at Amiata Volcano uses flash-type power plants with cooling towers that evaporate much of the geothermal fluid to the atmosphere to condense the geothermal vapour extracted. Because the flash occurs also within the geothermal reservoir, it causes a significant depressurization within it that, in turns, results in a drop of the water table inside the volcano between 200 and 300 m. The flow rates of natural springs around the volcano have also substantially decreased or ceased since the start of geothermal energy exploitation. Continuous recording of aquifer conditions shows substantial increases in salinity (>20%) and temperature (>2°C) as the water table falls below about 755–750 m asl. In addition to hydrologic impacts, there are also a large numbers of induced earthquakes, among which the ML 3.9, April 1, 2000 earthquake that generated significant damage in the old villages and rural houses. Relevant impacts on air quality occur when emissions are considered on a per-MW basis. For example, CO2+CH4 emissions at Amiata are comparable to those of gas-fired power plants (1), while the acid-rain potential is about twice that of coal-fired power plants. Also, a significant emission of primary and secondary fine particles is associated with the cooling towers. These particles contain heavy metals and are enriched in sodium, vanadium, zinc, phosphorous, sulphur, tantalium, caesium, thallium, thorium, uranium, and arsenic relative to comparable aerosols collected in Florence and Arezzo (2). Measurements have shown that mercury emitted at Amiata comprises 42% of the mercury emitted from all Italian industries, while an additional comparable amount is emitted from the other geothermal power plants of Tuscany (3). We believe that the use of air coolers in place of the evaporative cooling towers, as suggested in 2010 by the local government of Tuscany (4), could have and can now drastically reduced the environmental impact on freshwater and air. On the opposite side of the coin, air-coolers would increase the amount of reinjection, increasing the risk of induced seismicity. We conclude that the use of deep borehole heat exchangers could perhaps be the only viable solution to the current geothermal energy environmental impacts.