Highway maintenance workers (HMWs) have been exposed to a broad range of potentially toxic substances, including diesel fuels and exhaust, asphalts and tars, herbicides, gasoline, polynuclear aromatic hydrocarbons, benzene, and lead. The number of current and former state, county, and municipal HMWs in the United States exceeds 500,000, yet the health risks of this occupation had never been studied. To fill this void and to respond to the public perception that Minnesota HMWs were at high risk of developing leukemia, an occupational cohort mortality study was conducted of Minnesota HMWs employed between 1945 and 1984. Leukemia mortality in HMWs with 30-39 years of work (standardized mortality ratio [SMR] = 425; 95% confidence interval [CI] = 171-876) and urologic cancer mortality in HMWs with 40-49 year latency (SMR = 292; CI = 117-602) were significantly elevated. The extent to which these and other findings were directly related to work exposures is unknown. Further investigations to resolve the significance of the risks associated with the HMW occupation are currently underway.