OBJECTIVE. To introduce evidence of the critical link between water quality and human occupations.

METHOD. A participatory action research design was used to complete a three-phase project. Phase 1 included mapping the watershed of Letcher County, Kentucky. Phase 2 consisted of surveying 122 Letcher County health professionals. Phase 3, the primary focus of this article, consisted of interviews with Letcher County adults regarding their lived experiences with water. The Occupational Therapy Practice Framework: Domain and Process (American Occupational Therapy Association, 2002) was used to structure questions. The Model of Occupational Justice provided the theoretical framework for presentation of the results.

RESULTS. The watershed in Letcher County, Kentucky, is polluted as a result of specific coal mining practices and a lack of adequate infrastructure. As a result, citizens experience occupational injustice in the forms of occupational imbalance, occupational deprivation, and occupational alienation.