Coal mining in Appalachia is responsible for 15 percent of electricity production and 6 percent of greenhouse gas emissions in the U.S. It is also responsible for over 1 million acres of degraded lands, 2000 miles of polluted streams, and contributes to acid rain and mercury deposition. Mining impacts on Appalachia also includes some of the highest effects of heart disease, poverty and birth rates in the country. A new program, the Appalachian Transition Initiative, brings together regional scientists, engineers, community development professionals, environmental organizations and legislators to help develop a new Appalachian economy that is based on diverse and resilient enterprises. After a brief review of coal mining practices and consequences on the natural and social communities of Appalachia, examples will be presented of initiatives in current practice that sustain the integrity of the ecology, economy and overall health of the region.