Laura Wood Habr has lived a block from the beach nearly all her life. She’s the co-owner of Croc’s 19th Street Bistro, a sustainable, climate-friendly business. She sources seafood locally, uses solar panels, hosts environmental events, and works with her neighborhood to adapt to encroaching seas.

It’s no surprise, then, that Wood Habr is hyper aware of how offshore drilling could harm her Virginia Beach community. Several years ago, she helped fight offshore drilling efforts under the Obama administration to protect the Atlantic Coast. “This is a pristine place. Human health and environmental health are codependent,” she said. “Why would you want to risk that?”

Now, Wood Habr has to fight all over again.

On Thursday, the Department of Interior released a draft proposal to allow drilling in 90 percent of U.S. coastal waters, including protected areas in the Arctic and Atlantic. Not only does the move threaten marine ecosystems and wildlife, coastal fishing, tourism, and climate action, it also raises public health risks for communities along the coasts.

“There’s a lot of focus on oil spills, but that is not the only effect on communities and community health,” Donald Boesch, professor of marine science at the University of Maryland, told The Daily Beast. “Over the long term there’s a number of things associated with developing an intense offshore industry that affect the fabric of coastal communities and the health of people that live in them, even if there aren’t any oil spills.”

The Bureau of Ocean and Energy Management has identified 47 areas for offshore oil and gas leases in the Arctic Ocean, Pacific Ocean, Gulf of Mexico, and the Atlantic Ocean. The plan would span from 2019 to 2024, reversing an Obama-era order that banned oil and gas drilling in 94 percent of the Outer Continental Shelf, the submerged lands under federal jurisdiction. The proposal would open areas off the coast of California for the first time in decades, auction off 19 leases off the coast of Alaska, and 12 in the Gulf of Mexico.

Off the Atlantic Coast, where drilling has been banned since 1981, nine lease sales would be available under the proposed plan. It could potentially open up waters off Virginia Beach, a city that made $1.5 billion from tourism last year, worrying business owners like Wood Habr.

More than 140 communities along the Atlantic Coast from Virginia Beach to Savannah—both rural and urban, conservative and liberal—oppose the move. Almost every state governor along the Atlantic Coast and every governor along the Pacific Coast is against it, as are many state attorneys general. The Department of Defense has said drilling has risks for military operations and national security. Thousands of environmental groups and business associations have opposed it.

The overwhelming concern of offshore drilling opponents is the 2010 Deepwater Horizon explosion, especially since the Trump administration halted a study of offshore oil inspections and plans to kill or redo regulations on offshore operations. The Deepwater Horizon explosion, the largest marine oil spill in U.S. history, killed 11 BP workers and released 200 million gallons of crude oil into the Gulf of Mexico. Nearly a decade later, the region’s economy and marine life are still recovering.

It shut down fisheries and beaches and halted tourism, Sierra Weaver, a senior attorney and lead of the coastal and wetlands program for the Southern Environmental Law Center, told The Daily Beast. “[There were] a lot of public health impacts as well for people trying to clean up the spill and local residents,” she said. “You’re breathing fumes from petroleum products and from dispersants trying to clean up oil. All of those are toxic and going to affect public health.”

Big spills aren’t the only concern. According to Oceana, an ocean conservation organization, small spills associated with oil extraction, transportation, and consumption can add up to about 195 million gallons annually, almost the equivalent of the Deepwater Horizon spill.

Offshore drilling can take a toll on the physical and mental health of coastal communities. A 2016 study of women in Louisiana showed that some of those directly exposed to the Deepwater oil spill had respiratory problems like wheezing and coughing, and the economic costs of the spill impacted their health, as well.

Boesch said other research shows people who lived hundreds of miles from the spill site, on the Gulf coast of Florida, also showed signs of mental health problems because the region’s main economic engines shut down.“Economies are disrupted, tourism went away, fishing stopped—that caused enormous amounts of problems to health and minds of people in the community,” Boesch said. “Recovery has taken place, but there are lasting scars.”

Onshore infrastructure for offshore oil operations—refineries, pipelines, transportation traffic, storage facilities—add more risks. According to the EPA, people living in Cancer Alley, a stretch along the Mississippi River between Baton Rouge and Louisiana concentrated with petrochemical plants, face a high risk of developing cancer from air toxins. Some research shows Louisiana waterways around the plants are some of the most polluted in the country.

Building infrastructure would transform the economy and environment of the Pacific and Atlantic coasts. “In the Atlantic and Southeast coast, you’re mostly talking about non-industrialized areas, small beach towns or fishing communities that haven’t had to deal with large scale industrial activities,” Weaver said. Rapid sea level rise along the coasts makes it more complicated. “To think about putting more industrial activity in places so vulnerable is insanity,” she added.

Many Atlantic Coast economies rely on fishing and tourism. Seismic testing, which sends loud blasts deep into the ocean to search for oil and gas, can injure and kill marine life. For years after oil spills, fish can be contaminated by oil. Drilling in pristine areas in the Arctic could put endangered and endemic species at risk, wildlife scientists say, and threatens the way of life of many Alaska Native communities.

Though the Trump administration touts job growth and economics, offshore drilling opposition spans political, economic, and social lines. Peg Howell was one of the first women “company men” working in the Gulf of Mexico oil industry in the 1980s, she said, leading crews on Chevron oil rigs at sea. She left the industry because of an oil industry bust to become a consultant for oil and gas companies. But when South Carolina lawmakers pushed for drilling off the coast of her home of Pawleys Island a few years ago, she became active in the movement to ban it.

“Wells from 50 years ago [in the Gulf] are still producing and causing problems, so this is not a minor threat when the president is talking about leasing off coasts that have never been home to oil and gas production,” Howell said. “We take all the risks, locally we don’t get the jobs, and we get all the harm.”

This is just the beginning of a multi-year process to allow leasing, and construction operations would take years after that. Public hearings will be held in state capitals starting this month, according to the Interior Department—a move that many people worry will make it difficult for coastal communities to have their voices heard.

“We don’t want this to get too far down the road,” Wood Habr said. “We’re just going to have to be louder.”