The science and practice of river restoration has been building momentum and scale in the Pacific Northwest, and along with it, approaches to habitat restoration have evolved. Collectively, we’ve learned better ways to plan and design projects, opened thousands of stream miles through barrier removal, and have shifted our emphasis from river stability to river processes and dynamic change. Salmon productivity and species recovery are still limited, however. As we realize the breadth of river degradation and the ecosystems that depend on them, the work ahead must heal landscapes more broadly and cost effectively.