This report describes 11 newly identified cases of advanced coal workers' pneumoconiosis (CWP), including progressive massive fibrosis (PMF), in working coal miners from Lee and Wise counties in southwestern Virginia. PMF is a disabling and potentially fatal form of CWP, an occupational lung disease caused by the inhalation of coal mine dust. The continuing occurrence of advanced forms of CWP emphasizes the importance of comprehensive measures to control coal mine dust effectively and reduce the potential for inhalation exposures in coal mining.