Coal is vital to China's economic development. However, the burning of coal pollutes the air and can cause manifold health problems. This study focused on domestic coal consumption patterns and any concomitant trends in sulfur, arsenic, fluorine and mercury emissions in China during the 1991-2015 period. The most recently published domestic coal consumption statistics were collected, and data covering the emission levels and concentrations of sulfur, arsenic, fluorine and mercury released during the burning of domestic coal were obtained. We found that domestic coal consumption distribution patterns in China were spatially consistent with levels of atmospheric pollution. In 2015, the emissions of sulfur, arsenic, fluorine and mercury from domestic coal-burning amounted to 0.88 million tons, 213.28 t, 11,618.73 t and 15.89 t, respectively. These results showed a marked increase in rural emissions since 2002, and represented a total five times larger than urban emissions in 2015. Further, after 2008, there was a sharp increase in sulfur, arsenic, fluorine and mercury emissions from domestic coal-burning, in sharp contrast to the decrease in emissions from coal-fired power plants. These findings highlight the environmental impact of domestic coal consumption on rural communities, accelerating the need for more effective air pollution controls.