Municipal solid waste (MSW) compost is increasingly used in agriculture as a soil conditioner but also as a fertilizer. Proponents of this practice consider it an important recycling tool since MSW would otherwise be landfilled and critics are concerned with its often elevated metal concentrations. Large amounts of MSW compost are frequently used in agriculture to meet crop N requirements and for the addition of organic matter. The main concern is loading the soil with metals that can result in increased metal content of crops. Furthermore, in some cases, metals and excess nutrients can move through the soil profile into groundwater. Municipal solid waste compost has also been reported to have high salt concentrations, which can inhibit plant growth and negatively affect soil structure. A review of relevant agricultural studies is presented as well as recommendations for improving MSW compost quality. Its safe use in agriculture can be ensured with source separation (or triage of MSW to be composted) as well as the development and implementation of comprehensive industry standards.