Rural communities in South Africa are becoming increasingly reliant on freshwater fish to supplement their dietary protein requirement. Rising costs of other protein sources, increasing rural poverty and escalating rural populations are resulting in increasing consumption of fish from contaminated river systems. The Olifants River, Limpopo Basin, Eastern South Africa, has been systemically impaired and is now one of the most polluted rivers in South Africa. We measured the concentrations of metals in fish muscle tissue from two impoundments in the Olifants River (Flag Boshielo Dam and the Phalaborwa Barrage) and conducted a human health risk assessment following Heath et al., (2004) to investigate whether consumption of Oreochromis mossambicus from these impoundments posed a risk to the health of rural communities. Our results show that metals are accumulating in the muscle tissue of O. mossambicus even though the populations appear to be healthy. No patterns were observed in the ratios of the metals accumulated in the muscle tissue of O. mossambicus at each impoundment. The human health risk assessment identified that lead, antimony and chromium at Flag Boshielo Dam and lead at the Phalaborwa Barrage were above acceptable levels for the safe consumption based on a weekly 150 g fish meal. We conclude that consuming O. mossambicus from these impoundments could pose an unacceptable risk to the health of rural communities.