Past and current forest management affects wildland fire smoke impacts on downwind human populations. However, mismatches between the scale of benefits and risks make it difficult to proactively manage wildland fires to promote both ecological and public health. Building on recent literature and advances in modeling smoke and health effects, we outline a framework to more directly quantify and compare smoke impacts based on emissions, dispersion, and the size and vulnerability of downwind populations across time and space. We apply the framework in a case study to demonstrate how different kinds of fires in California's Central Sierra Nevada have resulted in very different smoke impacts. Our results indicate that the 257,314-acre Rim Fire of 2013 probably resulted in 7 million person-days of smoke impact across California and Nevada, which was greater than 5 times the impact per burned unit area than two earlier wildfires, Grouse and Harden of 2009, that were intentionally managed for resource objectives within the same airshed. The framework and results suggest strategies and tactics for undertaking larger-scale burns that can minimize smoke impacts, restore forest ecosystems, and reduce the potential for more hazardous wildfire and smoke events.