From the road, West Virginia's mountains look as pristine as ever, but from above, the landscape resembles more of a moonscape. From even higher up in space, entire swathes of countryside appear flattened.
Since the 1970s, 500 peaks and counting have been literally blown up for the coal that's deep underground. It's called mountaintop removal mining, and it's the subject of a new documentary called "The Last Mountain." It now surpasses mining that takes place underground in output.
When environmental campaigner Robert F. Kennedy, Jr. saw it for the first time, he was overwhelmed.
"If you try and blow up a mountain in the Berkshires or the Adirondacks or the Catskills or in Utah, Colorado, California -- you would be put in jail," he said. "The only reason you see mountain top removal happening in this country is because people don't know about it...nobody would allow this to happen."
With mountaintop removal mining, the trees, soil and land from a few hundred feet above and below ground level are dug up and pulverized for the coal that is underneath.
The mining has already cleared one million acres of forest, an area the size of Delaware, and buried 2,000 miles of streams, causing increased flooding. Selenium and other toxic metals have been found leaching into local waterways.
Health problems have also been reportedly linked to this specific type of mining.
A new study published in the journal Environmental Research finds a significantly higher rate of birth defects in areas where mountaintop removal mining is done compared to other mining and non-mining areas in the Appalachian region.
Higher rates of circulatory, respiratory, central nervous system, musculoskeletal, gastrointestinal and urogenital problems were reported through the study, which looked at 1.8 million live births between 1996 and 2003 in central Appalachia.
Jerry Aleshire lives at the foot of Blair Mountain, one of the next targets. He and his family have made a living from underground mining for generations, but they say mountaintop mining is destroying their community.
"Coal companies used to work with the people, now they work against them," said Herschel Aleshire.
"I've told my grandchildren this place may be yours, but it may not be there," said his daughter, Karen Norman.
"No one has ever come around here for anything to ask us how we feel about it," said Jerry Aleshire.
The mining company, Massey Energy, now owned by Alpha Resources, did not answer repeated requests to speak with ABC News, but it's called the mining cost-effective and safe, and claims to return the landscape close to its original state. West Virginia Congressman Nick Rahall agrees.
"What it means is jobs, and what it means is keeping your lights on," he said.
According to the Environmental Protection Agency, mountaintop removal mining creates fundamental changes that take years, decades, even hundreds of years to return the landscape to what it was before.
Some in the community agree as well with Rahall. But on the other side of an increasingly bitter struggle are the Aleshires -- and dozens of other local families -- who marched this weekend to save their mountain and, they hope, stop the mining for good.
"As a mother I think it stinks," said Paula Swearengin. "As a coal miner's daughter and my grandfather who was a coal miner, I think it really stinks."
The emotions run as deep as the coal. Just 40 miles away is the Upper Big Branch mine, where a 2010 explosion killed 29 miners. The mine's owner? Again, Massey Energy.
"They preach safety but their number one goal is coal," said Jerry Aleshire. "Coal comes before everyone else."
Including, say the Aleshires, their future and the future of a mountain they love.