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Ghana is urbanising rapidly, and over half of the country’s population have lived in urban areas since 2010. Although research has proliferated to explore Ghana’s urbanisation, there is a dearth of research that holistically explores the wider sustainability implications of urbanisation, offers comparative perspectives in the context of large and smaller urban areas, and provides a perspective of local level urbanisation in the context of resource extraction (mining). This study comparatively assesses two urban areas in Ghana (Kumasi and Obuasi), by conducting a spatio-temporal analysis of land cover change through remote sensing and by analysing demographic change through a synthesis of published population data, in order to highlight the sustainability implications of urbanisation. The results show that urbanisation has been rapid, and has resulted in changes in land cover and demography in Kumasi and Obuasi. The sustainability implications of urbanisation are identified to include limited economic opportunities, socio-spatial segregation, and destruction of natural vegetation. The evidence in this study provides insights into urbanisation in Ghana, and suggests that the positive sustainability impacts of urbanisation may be eroded by how factors such as market forces and land tenure interact at the local level.