Despite federally mandated safety standards, occupational lung disease remains one of the most common work-related injuries. Inhaled dust can result in a range of tissue injury in the lung and can lead to significant respiratory insufficiency causing death. Although silicosis and coal worker's pneumoconiosis are becoming less common, hypersensitivity pneumonitis is increasingly recognized as an occupational lung disease with new antigens being introduced annually. Imaging, particularly high-resolution computed tomography, is central to the management of occupational lung disease and is useful in diagnosis, assessment of disease activity, and evaluating response to therapy.