La Rinconada, perched at about 5,000 meters in the eastern Andes, is the world’s highest permanent settlement. This gold mining town in Peru has around 50,000 residents but lacks basic services like running water, sewage, or waste systems. It sits on the slopes of Mount Ananea, beneath a retreating glacier. Temperatures often fall below freezing, and the air contains half the oxygen found at sea level, which makes breathing and moving hard. The town grew from a mining camp over 40 years ago but never gained proper infrastructure. Electricity only arrived in the early 2000s. Garbage is often burned or buried. Water must be carried in by residents. Mining here happens through a system called cachorreo. Miners work many days without pay and can keep ore they carry home after the period. The gold extracted belongs to them. This risky system draws workers hoping for big gains. When gold prices rose in the early 2000s, La Rinconada’s population jumped by over 200% from 2000 to 2009. Newcomers arrived with hopes of striking it rich. But housing and services lagged behind this rapid growth. Living so high causes health issues. Many locals suffer from chronic mountain sickness, caused by low oxygen. Symptoms include headaches, dizziness, and heart problems. Scientists estimate one in four residents may be affected. Health facilities are scarce, and serious cases must be treated far below in the valley. Despite the harsh environment, retreating glacier, and health dangers, La Rinconada remains a driven town shaped by gold. No clear plan exists for its future. For now, people live with the thin air, cold, and uncertainty.