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The over one million agricultural workers in the United States (U.S.) are amongst the populations most vulnerable to the health impacts of extreme heat. Climate change will further increase this vulnerability. Here we estimate the magnitude and spatial patterns of the growing heat exposure and health risk faced by U.S. crop workers and assess the effect of workplace adaptations on mitigating that risk. We find that the average number of days spent working in unsafe conditions will double by mid-century, and, without mitigation, triple by the end of it. Increases in rest time and the availability of climate-controlled recovery areas can eliminate this risk but could affect farm productivity, farm worker earnings, and/or labor costs much more than alternative measures. Safeguarding the health and well-being of U.S. crop workers will therefore require systemic change beyond the worker and workplace level.