Throughout the world, coal is responsible for generating approximately 38% of power. Coal ash, a waste product, generated from the combustion of coal, consists of fly ash, bottom ash, boiler slag, and flue gas desulfurization material. Fly ash, which is the main component of coal ash, is composed of spherical particulate matter with diameters that range from 0.1 μm to >100 μm. Fly ash is predominately composed of silica, aluminum, iron, calcium, and oxygen, but the particles may also contain heavy metals such as arsenic and lead at trace levels. Most nations throughout the world do not consider fly ash a hazardous waste and therefore regulations on its disposal and storage are lacking. Fly ash that is not beneficially reused in products such as concrete is stored in landfills and surface impoundments. Fugitive dust emissions and leaching of metals into groundwater from landfills and surface impoundments may put people at risk for exposure. There are limited epidemiological studies regarding the health effects of fly ash exposure. In this article, the authors provide an overview of fly ash, its chemical composition, the regulations from nations generating the greatest amount of fly ash, and epidemiological evidence regarding the health impacts associated with exposure to fly ash.