Subtropical and tropical islands are undergoing rapid urbanization as human populations and tourism expand worldwide. Urbanization disrupts coastal ecosystems by replacing forests and other natural habitats with roads, parking lots, and buildings. These impervious surfaces increase the amount of runoff and pollution that reaches coastal ecosystems. Urbanization also comes with increased industry, waste treatment needs, fishing and aquaculture pressure, and coastline engineering. Despite the major changes to coasts that accompany urbanization, specific impacts on marine ecosystems can be difficult to measure due to missing baselines. Here, we take advantage of a large gradient in urbanization on the subtropical island of Okinawa, Japan, to evaluate the impact of urbanization on nearshore ecosystems. We measured physicochemical parameters and assessed bacterial community composition every two weeks for one year at two nearshore sites adjacent to watersheds with >70% urban land use and two nearshore sites adjacent to watersheds with >70% rural land use. Our results show that urbanization increases freshwater input and nutrient loading to nearshore ecosystems and profoundly alters the microbial community, overriding the natural seasonal succession observed at rural sites. At urban sites, we detected multiple bacterial species that are fecal indicators and human or marine organism pathogens. The altered physicochemical conditions and microbial communities at urban sites can contribute to the degradation of nearby coral reefs. Results highlight the importance of a ridge-to-reef management mindset, as restoring natural coastlines could buffer the impact of urbanization on the marine environment.