The Viburnum Trend is a lead mining district located in southeast Missouri.  In 2002-2005 we conducted a multidisciplinary study to assess the ecological effects of lead mining in the region.  The study included macroinvertebrate surveys, habitat assessments, toxicity exposures, and measurements of metal ions in sediment, porewater, and biota.  Among macroinvertebrate sites, we included reference sites with no known upstream mining activities and those downstream of active mining areas.  Macroinvertebrates were sampled to determine aquatic life use attainment status (full, partial, or non-support) and relationships between biotic condition scores and other environmental indicators.  Reference sites had the lowest metal ion concentrations in porewater and sediment, and among the highest macroinverterbrate scores in both sampling years.  Macroinvertebrate scores were significantly correlated with zinc (r = -0.65) and lead (r = -0.72) in 2003, and cadmium (r = -0.75) and lead (r = -0.82) in 2004.  Reference sites were fully-biologically supporting in both years.  Sites directly below mining areas were partially-biologically supporting, with macroinvertebrate scores from 10% to 58% lower than reference sites.  Results indicate that metals in streams of the Viburnum Trend have negative impacts on macroinvertebrate assemblages, and levels of impacts generally concurred with those identified by other indicators.