MTR is a form of surface mining that involves the mining of the summit or summit ridge of a mountain. Coal seams are extracted from a mountain by removing the land, or overburden, above the seams.

Less expensive to execute and requiring fewer employees, mountaintop removal mining began in Appalachia in the 1970s as an extension of conventional strip mining techniques. It is primarily occurring in Kentucky, West Virginia, Virginia, and Tennessee.

The practice of mountaintop removal mining has been controversial. The coal industry cites economic benefits and asserts that mountaintop removal is safer than underground mining. Published scientific studies have found that mountaintop mining has serious environmental impacts and a high potential for human health consequences.

Almost half of the electricity generated in the United States is produced by coal-fired power plants. MTR accounted for less than 5% of U.S.coal production. Much of the coal is sold overseas for profit.

Published studies also show a high potential for human health impacts. These may result from contact with streams or exposure to airborne toxins and dust. Adult hospitalization for chronic pulmonary disorders and hypertension are elevated as a result of county-level coal production. Rates of mortality, lung cancer, as well as chronic heart, lung and kidney disease are also increased

Extensive tracts of deciduous forests destroyed by mountaintop mining support several endangered species and some of the highest biodiversity in North America. There is a particular problem with burial of headwater streams by valley fills which causes permanent loss of ecosystems that play critical roles in ecological processes.