The electric utilities of North America have become ever more interconnected via transmission facilities, largely to insure reliability. Current policy discussions regarding transmission include calls for improved access, increased capacity, and deregulation to facilitate trade in electric power. From an environmental perspective, two issues have been notably absent in much of the debate: (1) a recognition of the full range of environmental impacts related to electricity transmission; and (2) the potential for end-use efficiency to address the reliability and economy requirements that motivate attention to transmission. This paper broaches these issues, starting with an elaboration of the environmental impacts, which range from global and regional effects to local concerns, including the potential health risks associated with electric and magnetic fields. We emphasize that transmission planning should occur as part of an integrated planning process, in which the environmental and social costs of various options are fully considered. We discuss the potential for end-use efficiency to lessen environmental impacts of both transmission and generation. We conclude that there is a need to ensure that environmental externalities and demand-side alternatives are adequately considered when transmission network expansions are proposed.