Limestone formations in the United States can be subject to relatively high horizontal stresses owing to the existence of tectonic loading of the limestone strata. Underground limestone mines use the room-and-pillar method, in which 12- to 18-m-wide rooms are typically excavated. The stability of these excavations can be compromised by the horizontal stress, resulting in a rock fall hazard. Rock falls are the cause of 15% of all reportable injuries in underground limestone mines. Horizontal stress related damage can occur in the form of guttering along one or more sides of an excavation, roof beam buckling or oval shaped roof falls, with the long axis perpendicular to the major horizontal stress. Numerical analyses show that the pillar layout and orientation of the mine workings has an effect on the horizontal stress distribution within the roof. The effects of high horizontal stresses can be mitigated by orienting the heading development direction parallel to the maximum horizontal stress, reducing the number of cross-cuts and off-setting the cross-cuts to limit the potential lateral extent of horizontal stress related roof falls. The modeling approach described in this paper can be used as a tool to evaluate potential roof failure and optimize the stability of room and pillar layouts.