Mountaintop mining and valley fill (MTM/VF) coal extraction, practiced in the Central Appalachian region, represents a dramatic landscape-scale disturbance. MTM operations remove as much as 300 m of rock, soil, and vegetation from ridge tops to access deep coal seams and much of this material is placed in adjacent headwater streams altering landcover, drainage network, and topography. In spite of its scale, extent, and potential for continued use, the effects MTM/VF on catchment hydrology is poorly understood. Previous reviews focus on water quality and ecosystem health impacts, but little is known about how MTM/VF affects hydrology, particularly the movement and storage of water, hence the hydrologic processes that ultimately control flood generation, water chemistry, and biology. This paper aggregates the existing knowledge about the hydrologic impacts of MTM/VF to identify areas where further scientific investigation is needed. While contemporary surface mining generally increases peak and total runoff, the limited MTM/VF studies reveal significant variability in hydrologic response. Significant knowledge gaps relate to limited understanding of hydrologic processes in these systems. Until the hydrologic impact of this practice is better understood, efforts to reduce water quantity and quality problems and ecosystem degradation will be difficult to achieve.