In recent years, miners have experienced a deadlier resurgence of Coal Workers’ Pneumoconiosis (CWP), commonly known as black lung disease in central Appalachia. This research utilizes a qualitative approach and relies on several forms of data including: semi-structured interviews, direct observation, newspaper coverage, and government data and reports. Major findings suggest that the “coal crisis” (i.e. depleted seams, mechanization, competition from natural gas, and deunionization) have intensified the resurgence of black lung in central Appalachia and has contributed to a “culture of fear” among active coal miners. This research elucidates multiple issues faced by coal miners and the coal industry in general. As the coal industry has expanded production, it has generated greater environmental externalities and increased environmental health risks for miners. This problem is further complicated and intensified by the vast economic problems in Appalachia. The lack of alternative employment opportunities and protection in the workplace has created a “culture of fear” which leaves employed miners fearful of job loss and retaliation for speaking out. Furthermore, miners postpone black lung screening and diagnosis, fearing being stigmatized as sick and unable to work. This research offers a viable opportunity to discuss an obscured disease in hopes of mitigating future cases of black lung.