Recent reports indicate that black lung rates in Appalachia are at their highest levels in nearly 50 years, with thousands of miners afflicted by this debilitating disease. Despite the alarming rise in rates comparable to those of the 1970s, protections for coal miners have stagnated, raising concerns about the health and safety of workers in the region. A new study underscores the severity of this public health crisis as efforts to improve miner protections continue to stall.