This article presents the first panel‐data evidence of a human health externality from the air pollution generated by surface coal mining. In West Virginia, a standard deviation increase in a county's exposure to surface coal mining is associated with 9.85 more asthma hospitalizations per 100,000 residents in a given quarter. Interpreted causally, this suggests over $11 million in hospitalization costs over the 6‐year study period. The study builds on earlier cross‐sectional research by controlling for unobserved county‐level heterogeneity, and by defining more accurate measures of exposure. Both methods are shown to reduce the bias associated with earlier estimates of coal mining's effect on health. Young and elderly women demonstrate the largest sensitivities to surface mining. Falsification tests reveal that neither hernias nor bone fractures demonstrate any relationship with surface mining activity.
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