Cyanidation in gold extraction has detrimental impacts on the ecosystem and the population in surrounding areas. The research described in this article aimed to assess the health effects of environmental exposure to cyanide in a community near a gold mining area in Malaysia. A total of 255 members of the exposed community and 117 members of the control community answered questionnaires on their exposure to a gold mine and health outcomes. Urine samples were collected for biomarker assessment (i.e., urinary thiocyanate). The authors found that the mean level of urinary thiocyanate was significantly higher among the exposed community (0.30 ± 0.26 mg/dL) than the control community (0.24 ± 0.23 mg/dL) (p = .0021). The exposed community had a significantly higher prevalence of headaches (prevalence odds ratio [pOR] = 2.6, p = .001), dizziness (pOR = 3.7, p < .001), skin irritation (pOR = 2.1, p = .040), and eye irritation (pOR = 5.1, p = .004). No association occurred between dietary exposure and urinary biomarkers. Smokers living near a gold mine had a higher urinary thiocyanate level (0.56 mg/dL) than smokers in the control community (0.49 mg/dL).