This report summarizes a national assessment of the ecological health of streams done by the U.S. Geological Survey’s (USGS) National WaterQuality Assessment Program (NAWQA). Healthy functioning stream ecosystems provide society with many benefits, including water purification, flood control, nutrient recycling, waste decomposition, fisheries, and aesthetics. The value to society of many of these benefits is substantial; for example, sportfishing in the United States generates an estimated annual economic output of $125 billion, including more than 1 million jobs (National Research Council, 2005; American Sportfishing Association, 2008). Continued monitoring and assessment of the Nation’s streams is needed to support informed decisions that will safeguard this important natural and economic resource.