© 2019, © 2019 Taylor & Francis Group, LLC. Coal ash is a waste product generated when coal is burned for energy. The purpose of this study was to assess health symptoms in adults living near a coal-burning power plant and compare the symptoms to a non-exposed population. A community-based mixed methods study was conducted with four neighborhoods adjacent to a coal-burning power plant. The comparison population was not exposed to coal ash and did not live near a coal-burning power plant. Adults who lived near the coal-burning power plant were significantly more likely to suffer from respiratory (AOR = 5.27, 95% CI = 2.16–12.0), gingiva (AOR = 2.46, 95% CI = 1.46–4.15), and skin symptoms (AOR = 3.37, 95% CI = 2.09–5.43). Results suggest that health symptoms may develop in people living near coal-burning power plants.