Chemical modifications of RNA molecules have gained increasing attention since evidence emerged for their substantive roles in a range of biological processes, such as the stability and translation of mRNA transcripts. More than 150 modifications have been identified in different organisms to date, collectively known as the ‘epitranscriptome’, with 6-methyladenosine (m6A), 5-methylcytidine (m5C), pseudouridine and N1-methyladenosine (m1A) the most extensively investigated. Although we are just beginning to elucidate the roles of these modifications in cellular functions, there is already evidence for their dysregulation in diseases such as cancer and neurodevelopmental disorders. There is currently more limited knowledge regarding how environmental exposures affect the epitranscriptome and how this may mediate disease risk, but evidence is beginning to emerge. Here, we review the current evidence for the impact of environmental exposures such as benzo[a]pyrene, bisphenol A, pesticides, metals and nanoparticles upon RNA modifications and the expression of their ‘writers’ (methyl transferases), ‘erasers’ (demethylases) and ‘readers’. We discuss future directions of the field and identify areas of particular promise and consider the technical challenges that are faced.