This report, prepared by the Office of Technology Assessment of the United States Congress, assesses the benefits and risks of a massive shift to coal and away from other fuels. It deals with the social, economic, physical, and biological impacts of such a shift. It examines the complete coal system, from extraction to combustion, including the key steps and institutions that policy can influence. The environmental impacts and possible effects on the public health are documented. Occupational and community impacts are examined. Technologies under development that might reduce costs, increase convenience of use, or mitigate negative impacts are reviewed.