Human use of river systems has intensified considerably in the last century due to increasing population and the associated higher demand for water through industrial and agricultural technologies. This intensification process has impacted rivers and resident organisms. Natural rivers have rich and varied fish faunas adapted to the variable climate and morphology of such systems. Much of the diversity and resilience can be traced to the connectivity between two very different components, the channel and the floodplain. Fisheries in rivers are as diverse as the fish communities and are adjusted for capturing most species and life stages throughout the year. Fisheries reasonably conducted have proved sustainable with a high rate of catch correlated with the intensity of flooding in the same or preceding years. Fish communities react in a predictable manner to externally imposed stresses, whether eutrophication, induced by humans or natural environmental modification, or fishing, through successive loss of large species and their replacement by smaller, faster growing species. Generally, the overall weight of catch remains little affected by this process until excessive levels of exploitation are reached and the stock collapses. Damage to fish communities through overfishing and environmental modification is widespread. Improvement of the situation demands stricter management of riverine systems through the protection of the few that remain in a relatively pristine state, and those modified should be restored if social, political and economic conditions allow. Should this not be possible, approaches to the mitigation of externally imposed stresses should be sought and applied.