In the confined spaces of underground mines, the exposure of over 10,000 miners in the U.S. to diesel exhaust and diesel particulate matter (DPM) is an occupational inevitability, particularly in metal and nonmetal mineral extraction. These workers routinely operate amidst diesel-powered equipment, often outdated and highly polluting, extracting resources such as limestone, gold, and salt. The acute health effects of such exposure are significant, leading to symptoms like headaches and flu-like conditions, with the impact being more pronounced in these closed work environments. This review scrutinizes DPM’s hazard in the mining sector, consolidating the extant knowledge and exploring ongoing research. It encapsulates our understanding of DPM’s physicochemical properties, existing sampling methods, health ramifications, and mitigation technologies. Moreover, it underscores the necessity for further study in areas such as the evolution of DPM’s physicochemical attributes, from its genesis at high-pressure, high-temperature conditions within diesel engines to its emission into the mine atmosphere. A key research gap is the intricate interaction of DPM with specific characteristics of the mine environment—such as relative humidity, ambient temperature, the presence of other mineral dust, and the dynamics of ventilation air. These factors can significantly alter the physicochemical profile of DPM, influencing both its in-mine transport and its deposition behavior. Consequently, this can affect the respiratory health of miners, modifying the toxicity and the respiratory deposition of DPM particles. Identified research imperatives include (1) the advancement of instrumentation for accurate number measurement of DPM to replace or supplement traditional gravimetric methods; (2) the development of long-lasting, cost-effective control technologies tailored for the mining industry; (3) an in-depth investigation of DPM interactions within the unique mine microclimate, considering the critical components like humidity and other aerosols; and (4) understanding the differential impact of DPM in mining compared to other industries, informing the creation of mining-specific health and safety protocols. This review’s findings underscore the urgency to enhance emission control and exposure prevention strategies, paving the way for a healthier underground mining work environment.