The natural range of fish species in our rivers is related to flow, elevation, temperature, local habitat and connectivity. For over 2000 years, humans have altered to varying degrees the river habitat. In the past 200 years, we added to the environmental disruption by discharging poorly treated sewage, nutrients and industrial waste into our rivers. For many rivers, the low point arrived during the period of 1950s–1970s, when rapid economic development overrode environmental concerns and dissolved oxygen concentrations dropped to zero. In these more enlightened times, gross river pollution is a thing of the past in the Developed World. However, persistent legacy chemical contaminants can be found in fish long after their discharge ceased. Changes in habitat quality and morphology caused and continue to cause the disappearance of fish species. The range of fish stressors has now increased as temperatures rise, and non-native fish introductions bring new diseases. The threat from pharmaceuticals to fish populations remains hypothetical, and no studies have yet linked change in fish populations to exposure.