This paper addresses the ability of five low-cost reactive materials to remove Zn, Pb, and Cd from Fe-poor, circum-neutral pH metal mine water in Mid-Wales, UK. Compost, fly ash, waste shell material, iron ochre, and a mixture of blast furnace slag (BFS) and basic oxygen furnace slag (BOS) were used in a series of small-scale passive treatment cells to assess metal removal from mine drainage initially containing, on average, 23.5 mg/L Zn, 0.5 mg/L Pb, and 0.05 mg/L Cd. Trial treatment cells contained between 1.5 and 12 kg of reactive media, had a 15 min residence time, and treated a discharge of up to 1 L per minute. Fly ash from a peat-fired power station was found to be the most effective material for metal removal, with concentrations reduced to 0.02 mg/L Zn, 0.0069 mg/L Pb, and 0.0001 mg/L Cd from over 1,000 L of water (between 98.6 and 99.9% removal). The other materials initially achieved high levels of metal removal (between 75 and 99.9% Zn, Pb, and Cd removed); however, all of the materials were saturated with Zn after less than 200 L of water had been treated. Metal sorption ranged from 21.4 mg/g Zn for the peat fly ash to 0.0015 mg/g Cd for the compost and BOS/BFS slag. The results of the pilot-scale field trials can be scaled to demonstrate that a modest-sized fly ash treatment cell (2.6 × 2.6 × 1 m) in size would be sufficient to remove 90% of the total metal load (Pb, Zn, and Cd) from this 10 L/min mine water discharge for a 1 year period. Importantly this research demonstrates that passive treatment for metal mine drainage can comply with water quality directives but cannot be considered a ‘walk-away’ solution; it requires modest (potentially annual) maintenance.