This article investigates how the health disparities of Appalachian coal miners and coal mining communities could be decreased through a partnership with occupational health nurses. On-site health clinics managed by occupational health nurses working in the coal mining industry are proposed as a means to improve health care outcomes. Health effects, economic considerations, environmental impacts, and U.S. coal mining legislation and regulation are examined. An epidemiological approach is presented to the unique health effects experienced by Appalachian coal miners and coal mining communities within the context of existent socioeconomic disparities. The long-standing health crisis in Appalachian coal mining communities requires a multidisciplinary approach led by occupational health nurses.