Objective To estimate the population of Peru living in the vicinity of active or former mining operations that could be exposed to lead from contaminated soil. Methods Geographic coordinates were compiled for 113 active mines, 138 ore processing plants and 3 smelters, as well as 7743 former mining sites. The population living within 5 km of these sites was calculated from census data for 2000. In addition, the lead content of soil in the historic mining town of Cerro de Pasco and around a recent mine and ore processing plant near the city of Huaral was mapped in 2009 using a hand-held X-ray fluorescence analyser. Findings Spatial analysis indicated that 1.6 million people in Peru could be living within 5 km of an active or former mining operation. Two thirds of the population potentially exposed was accounted for by 29 clusters of mining operations, each with a population of over 10 000 each. These clusters included 112 active and 3438 former mining operations. Soil lead levels exceeded 1200 mg/kg, a reference standard for residential soil, in 35 of 74 sites tested in Cerro de Pasco but in only 4 of 47 sites tested around the newer operations near Huaral. Conclusion Soil contamination with lead is likely to be extensive in Peruvian mining towns but the level of contamination is spatially far from uniform. Childhood exposure by soil ingestion could be substantially reduced by mapping soil lead levels, making this information public and encouraging local communities to isolate contaminated areas from children.