The Wadeable Streams Assessment (WSA) provided the first statistically sound summary of the ecological condition of streams and small rivers in the US. Information provided in the assessment filled an important gap in meeting the requirements of the US Clean Water Act. The purpose of the WSA was to: 1) report on the ecological condition of all wadeable, perennial streams and rivers within the conterminous US, 2) describe the biological condition of these systems with direct measures of aquatic life, and 3) identify and rank the relative importance of chemical and physical stressors affecting stream and river condition. The assessment included perennial wadeable streams and rivers that accounted for 95% of the length of flowing waters in the US. The US Environmental Protection Agency, states, and tribes collected chemical, physical, and biological data at 1392 randomly selected sites. Nationally, 42% of the length of US streams was in poor condition compared to best available reference sites in their ecoregions, 25% was in fair condition, and 28% was in good condition. Results were reported for 3 major regions: Eastern Highlands, Plains and Lowlands, and West. In the West, 45% of the length of wadeable flowing waters was in good condition. In the Eastern Highlands, only 18% of the length of wadeable streams and rivers was in good condition and 52% was in poor condition. In the Plains and Lowlands, almost 30% of the length of wadeable streams and rivers was in good condition and 40% was in poor condition. The most widespread stressors observed nationally and in each of the 3 major regions were N, P, riparian disturbance, and streambed sediments. Excess nutrients and excess streambed sediments had the highest impact on biological condition; streams scoring poor for these stressors were at 2 to 3× higher risk of having poor biological condition than were streams that scored in the good range for the same stressors.