Respirable crystalline silica (RCS) exposures in tanzanite gem mining have been linked to tuberculosis and silicosis among miners. We conducted a plot study to assess RCS exposures and to introduce safer mining practices in one small-scale underground tanzanite mine. Personal and area air samples for RCS were collected during tanzanite mining operations before and after improved work practices employed to reduce exposures and analyzed using X-ray diffraction. Area samples were collected at the rest area, located approximately 300 m underground and 100 m from other work activities. Improved practices included the use of wet drilling methods and drilling with new bits. A total of 33 personal and 4 area air samples were collected. Pre-intervention, mean exposures for all operations, drilling operations, non-drilling activities, and area samples were 122 mg/m3, 247 mg/m3, 34.3 mg/m3, and 1.95 mg/m3, respectively which exceeded the U.S. OSHA Permissible Exposure Limit (PEL) by 2,440 times for all operations, by 4,946 times for drilling operations, by 686 times for non-drilling activities and 39 times for area samples collected at an underground rest area. The post-intervention results showed a 99% reduction of RCS exposures for wet drilling operations, 98.5% reduction for non-drilling activities, and 36% reduction for area samples. Despite improvements, post-intervention RCS exposures during drilling had a mean of 2.08 mg/m3 or more than 41 times the OSHA PEL. We successfully piloted a program to work with small-scale tanzanite miners to reduce RCS exposures and raise awareness about the occupational health risks of RCS, though additional measures are recommended to further reduce RCS exposures. Similar programs should be taken to scale throughout underground mining sites in Tanzania and other countries.