People making a living in rural Antioquia, Colombia, find themselves in a double bind: they require a healthy environment to farm and grow food, but many turn to artisanal and small-scale gold mining (ASGM) to supplement their incomes. The significant environmental harms associated with ASGM – from mercury and other heavy-metal contamination to deforestation and habitat loss – have led to both academic and popular discourse treating ASGM as an environmental problem to be understood and remedied scientifically. Our research in the small town of Andes (Antioquia region in Colombia) investigated how local residents themselves understood "pollution." Drawing on a literature review, archival research, site visits, and interviews with experts and local residents, we show that rural people understood pollution as emergent from complex webs of relationships and longer histories of government neglect. Exploring how people made sense of harm and expressed care builds on research in STS that demonstrates both the potentials and pitfalls for scientific concepts and tools to understand and intervene in compromised environments.