Water from abandoned underground coal mines acidifies receiving streams in the Sugar Creek Basin and Mitchell Mine Basin near Huntsville, Missouri. A 4.35-kilometer (2.7-mile) reach of Sugar Creek has been classified as impaired based on Missouri's Water Quality Standards because of small pH values [< (less than) 6.5]. Samples collected from Sugar Creek from July 2003 to June 2004 did not have pH values outside of the specified range of 6.5 to 9.0. However, large concentrations of iron [416 to 2,320 mg/L (milligrams per liter)], manganese (8.36 to 33.5 mg/L), aluminum (0.870 to 428 mg/L), and sulfate (2,990 to 13,700 mg/L) in acidic mine drainage (AMD) from two mine springs as well as small and diffuse seeps were observed to have an effect on water quality in Sugar Creek. Metal and sulfate loads increased and pH decreased immediately downstream from Sugar Creek's confluence with the Calfee Slope and Huntsville Gob drainages that discharge AMD into Sugar Creek. Similar effects were observed in the Mitchell Mine drainage that receives AMD from a large mine spring. Comparisons of water-quality samples from this study and two previous studies by the U.S. Geological Survey in 1987-1988 and the Missouri Department of Natural Resources in 2000-2002 indicate that AMD generation in the Sugar Creek Basin and Mitchell Mine Basin is declining, but the data are insufficient to quantify any trends or time frame. AMD samples from the largest mine spring in the Calfee Slope subbasin indicated a modest but significant increase in median pH from 4.8 to 5.2 using the Wilcoxan rank-sum test (p <0.05) and a decrease in median specific conductance from 5,000 to 3,540 ?S/cm (microsiemens per centimeter at 25 degrees Celsius) during a 17-year period. AMD samples from the largest mine spring in the Mitchell Mine Basin indicated an increase in median pH values from 5.6 to 6.0 and a decrease in median specific conductance from 3,050 to 2,450 ?S/cm during the same period. Remediation of AMD at or near the sites of the three largest mine springs is geochemically feasible based on alkalinity addition rates and increased pH determined by cubitainer experiments and geochemical mixing experiments using the computer model PHREEQCI. Alkalinity values for seven cubitainer experiments conducted to simulate anoxic treatment options exceeded the targeted value for alkalinity [90 mg/L as calcium carbonate (CaCO3)] specified in Missouri's Total Maximum Daily Load program by 18 percent or more, but maximum pH values were between 6.2 and 6.3, which is less than the targeted pH value of 6.5. Treatment of AMD by mixing with stream water or sewage effluent can further increase pH as indicated by geochemical modeling, but will not totally achieve water-quality goals because of limited discharges. A combination of treatments including settling ponds, oxic or anoxic limestone drains, and possibly successive alkalinity producing systems to remediate AMD will likely be required in the Sugar Creek Basin and Mitchell Mine Basin to consistently meet Missouri's Water Quality Standards.