Like all types of farming, raising tobacco has many hazards that may lead to injury, disability, or death. Burley tobacco farming is a multistep process that is not highly mechanized. An 8-year emergency department surveillance system in Kentucky identified 674 injury cases related to the production of burley tobacco. Most of the injuries were a result of a fall, cutting and piercing instruments, or sprains and strains. More than 90% of the injured patients were treated as outpatients, and the average charge for emergency room services was $402 (range, $0 to $14,729). One quarter of the patients were uninsured. Injuries to Hispanic workers increased over the 8-year period. Estimated hospital charge per acre of tobacco produced ranged from $1.28 to $1.74. Low-cost interventions such as gloves and chaps could reduce the injuries incurred in burley tobacco farming.