This study develops alkali-activated mine tailing (MT)-based binders containing MT as the major source material and slag (S) as a minor additive, using alkaline activators containing sodium or potassium as the cationic species. The influence of the cationic species (Na or K), slag content, alkalinity (expressed using the activator silica modulus, Ms), and alkali oxide-to-powder ratio, n, on the setting behavior, paste rheology, early-age reaction kinetics, and compressive strength development are discussed. The effects of using solid activators are also considered. Changes in Ms values have a stronger impact on setting times compared to n values, underscoring the significant role of silicate species from the activator in the initial reaction mechanisms. The type of cation and physical state of the activator (in the case of K–Si-activated systems) are found to determine the dissolution rate and mobility of ionic species in the system, resulting in significant differences in the early age reaction mechanisms (e.g., K-based activators show >2× enhancement in early heat release as compared to Na-based activators) of the alkali-activated binders prepared using the same activator parameters. The difference in the viscosities of the activator solutions strongly influences the rheological characteristics of the activated systems. MT-based binders with 28-day compressive strengths ranging from 10 to 35 MPa, which are suitable for several structural/non-structural applications, are attained. The strong dependence of the compressive strength development on the alkali activation parameters and slag content in the system presents an opportunity to develop sustainable binders, with MT as their major constituent, to provide twin benefits of recycling MT wastes and mitigating the environmental impacts associated with traditional ordinary Portland cement-based binder systems.