Coal is the second largest source of energy worldwide. As global energy demands continue to rise, coal will remain an important fuel source for years to come. Coal mine dust lung disease (CMDLD) describes the spectrum of respiratory diseases caused by coal mine dust and includes coal workers’ pneumoconiosis (CWP), mixed-dust pneumoconiosis, chronic obstructive pulmonary disease (COPD), and diffuse dust-related fibrosis (DDF). Estimates of the worldwide prevalence of CMDLD are unknown due to the lack of reliable information. It is recognized that the prevalence is greater in developing countries where working conditions are not well regulated. Strictly enforced dust control limits in the developed world have resulted in a declining prevalence of CMDLD. However, some countries have seen resurgence in both the prevalence and severity of CMDLD in the last 15 years. There is no cure for CMDLD, and it can progress even after exposure has ceased. Primary prevention of CMDLD, mainly through engineering controls to limit the presence of respirable dust, is therefore of critical importance. These methods include dust suppression techniques and ventilation plans. Unbiased dust sampling programs are needed to evaluate the effectiveness of these controls. Personal protective equipment provides inadequate protection due to difficulty with continuous use. Early detection of CMDLD using well-designed medical surveillance screening programs for coal miners is recommended. These programs should include chest imaging, spirometry, and clinical questionnaires. Detection of early disease allows for medical workplace removal as well as evaluation and implementation of improved environmental safety controls that can protect the respiratory health of all miners.