Ecological research on mountaintop mining has been focused on aquatic impacts because the overburden (i.e., the mountaintop) is disposed of in nearby valleys, which leads to a wide range of water-quality impacts on streams. There are also numerous impacts on the terrestrial environment from mountaintop mining that have been largely overlooked, even though they are no less wide ranging, severe, and multifaceted. We review the impacts of mountaintop mining on the terrestrial environment by exploring six broad themes: (1) the loss of topographic complexity, (2) forest loss and fragmentation, (3) forest succession and soil loss, (4) forest loss and carbon sequestration, (5) biodiversity, and (6) human health and well-being.