Lead is a natural element that is persistent in water and soil. Human exposure occurs primarily through diet, air, drinking water, and ingestion of paint chips. Absorption is increased in persons suffering from iron and calcium deficiency. Lead is a multitargeted toxicant, causing effects in the gasrtointestinal tract, hematopoitic system, cardiovascular system, central and peripheral nervous systems, kidneys, immune system, and reproductive system. The present study is medical and environmental assessment of some cases of residential lead poisoning appeared, on November 2003, in some rural communities in Assiut Governorate. The study included thirty eight persons of both sexes belonging to three rural families. One of these families was living in the North of Assiut City, while the other two families were living in two separate areas in the Western of Assiut City. Twenty one persons of these families were admitted to the Department of Tropical Medicine and Gastroenterology of Assiut University Hospital. They were complaining of severe intermittent abdominal pain and constipation. They were subjected to clinical and hematological examination in addition to blood and urine lead level estimation. The same was done to the other members of these families in addition to analysis of some environmental samples (drinking water, wheat and interior soil) by Graphite Furnace Atomic Absorption Spectrometry. Blood and urine analysis revealed high lead levels. There were significant relationship between these levels and the presence of anorexia, vomiting, colic and constipation, and highly significant relationship between these levels and the presence of Burton’s lines and basophilic stippling. The results of drinking water, soil and wheat analysis revealed very high lead levels exceeding the recommended levels. The results indicated that people in these communities are exposed to lead by ingesting contaminated water, food, dust and other materials or by inhaling airborne particulate matter that contains lead. Additional studies and interventions will be needed to address these situations. Many different organizations (both public and private) have to be involved in its abatement.