Over recent months, there has been much conversation about the possibility of a casino being built in the City of Toronto. The debate has largely focused on the potential of a casino to provide a new revenue stream for the city and the casino’s possible social costs. The potential health and health equity impacts of a casino in Toronto have, however, not been adequately discussed. In this health equity impact assessment, we set out how casinos contribute to problem gambling and identify the associated negative health impacts. We also demonstrate how an increase in problem gambling would disproportionately affect the health of people with low income, new Canadians, seniors, and young people. We conclude that, in light of the health and health equity impacts of problem gambling, council should reject a casino for Toronto.