The Bowen Basin in Central Queensland is one of the most active coal mining regions in Australia. Coal mining is highly lucrative and a major contributor to the Australian economy. However, that industry is also responsible for many social and environmental impacts, including air and water pollution, soil erosion, destruction of biodiversity, health-related issues and reduced community cohesion in mining areas. With pressing issues like climate change requiring an energy transition and the danger posed to the Australian economy by an over-reliance on coal exports, the decision to support that industry becomes increasingly questionable. In this study, we compare coal mining, livestock grazing and nature conservation expansion scenarios in the Bowen Basin over a 31-year period. We conduct a hybrid cost-benefit analysis, combining primary data and semi-quantitative weightings constructed from a social impact risk matrix. We estimate the net public benefits of each land use option, and the externalities that they may generate. When solely considering the economic benefits of each scenario, coal mining is by far the better option, generating 10 to 14 times more benefits than grazing and 800 to 3000 times more benefits than nature conservation. However, when including the costs of negative externalities, we find that the net present value of coal mining becomes negative (-$538 to -$690 billion on average), while grazing ($2.84 to $2.85 billion) and nature conservation ($16.35 to $79.29 million) remain positive. Therefore, this study contributes to the much-needed literature that can help demonstrate the many impacts of coal mining and the long-term risks that industry may pose to local communities in regional areas of Australia.