This study examines the relationship between depression symptoms and living in areas where mountaintop removal coal mining is practiced. Data were analyzed from a survey of 8,591 adults residing in Central Appalachian areas both with and without coal mining. The survey included a validated measure of depression severity. Results showed that diagnosable levels of major depression were present in almost 17% of respondents in mountaintop removal mining areas, compared to 10% of residents in non-mining areas. This disparity was partly attributable to socioeconomic disadvantage, but after statistical control for income, education, and other risks, depression risk for residents in the mountaintop removal area remained significantly elevated (odds ratio=1.40, 95% confidence interval 1.15-1.71). This study contributes to the empirical evidence in support of the concept of solastalgia and indicates that persons who experience environmental degradation from mountaintop removal coal mining are at elevated risk for depression.