Land application of Class B biosolids is routinely undertaken in the United States. However, due to public concern over potential hazards, the long-term sustainability of land application has been questioned. Thus, the objective of this review article was to evaluate the sustainability of land application of Class B biosolids. To do this we evaluated (i) the fate and transport of potential biological and chemical hazards within biosolids, and (ii) the influence of long-term land application on the microbial and chemical properties of the soil. Direct risks to human health posed by pathogens in biosolids have been shown to be low. Risks from indirect exposure such as aerosolized pathogens or microbially contaminated ground water are also low. A long-term land application study showed enhanced microbial activity and no adverse toxicity effects on the soil microbial community. Long-term land application also increased soil macronutrients including C, N, and, in particular, P. In fact, care should be taken to avoid contamination of surface waters with high phosphate soils. Available soil metal concentrations remained low over the 20-yr land application period due to the low metal content of the biosolids and a high soil pH. Soil salinity increases were not detected due to the low salt content of biosolids and irrigation rates in excess of consumptive use rates for cotton. Our conclusion, based on these studies, is that long-term land application of Class B biosolids is sustainable.