Significance Increased extreme heat exposure from both climate change and the urban heat island effect threatens rapidly growing urban settlements worldwide. Yet, because we do not know where urban population growth and extreme heat intersect, we have limited capacity to reduce the impacts of urban extreme heat exposure. Here, we leverage fine-resolution temperature and population data to measure urban extreme heat exposure for 13,115 cities from 1983 to 2016. Globally, urban exposure increased nearly 200%, affecting 1.7 billion people. Total urban warming elevated exposure rates 52% above population growth alone. However, spatially heterogeneous exposure patterns highlight an urgent need for locally tailored adaptations and early warning systems to reduce harm from urban extreme heat exposure across the planet’s diverse urban settlements.