W hile energy production using gas, nuclear, and solar power has recently increased in North Carolina, coal-fired electrical power plants remain the major source of net electricity generation: in 2017, 4,363 thousand megawatts (MWh) were generated from coal-fired sources; this is much greater than from nuclear power (the 2nd largest source at 3,811 thousand MWh) or gas-fired plants (the 3rd largest source, at 3,650 thousand MWh) [1]. Generation of electricity from the 14 coal-fired power plants in North Carolina results in the annual exhaust of 19.3 billion gallons of coal ash, with individual emissions ranging from 216 million gallons in Eden to over 4.1 billion gallons in Walnut Cove [2]. Coal-fired power plants can impact human health directly (eg, through immediate exposure to contaminated air and water) and indirectly (via exposure of coal and its by-products in the food chain) [3]. Coal combustion could also contribute to climate change that, in its turn, could lead to a higher frequency of floods, hurricanes, and droughts, a higher risk of development of allergic diseases, a higher prevalence of tick-and mosquito-borne diseases, as well as a higher risk of heat-related mortality [4, A1, A2]. At present, information about the health impact of coal-fired plants on human health, including the health of the residents of communities located in close proximity to coal power plants, remains sparse. We reviewed the literature to highlight the reports on potential health effects of pollution resulting from coal burning and coal ash storage. Objective, Method, and Inclusion and Exclusion Criteria The objective of this review was to summarize current knowledge on the health effects potentially associated with exposure to emissions from coal-burning power plants and to environmental contaminants from coal ash impoundments. The literature search, study selection, data extraction, and synthesis were performed between January 17, 2018, and June 19, 2018. We searched for English-language publications that were published between January 1, 1987, and December 31, 2017. To search for information, we used PubMed, Google Scholar, and also searched for additional studies from the reference lists of identified manuscripts that were related to the topic (see Figure 1). The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [A3]. The keywords used in the search were "coal," "coal ash," "coal power plant," "coal-burning power plant," "coal ash impoundment," "coal ash pond," and "fly ash." The detailed list of combinations of words for search is shown in Table 1.