Streams in the Midwest of the United States have experienced major changes in their watersheds since European settlement that have altered sediment loads, runoff, nutrient concentrations, and the abundance of woody debris. Moreover, the near extirpation of keystone species such as beaver, and the construction of dams and impoundments (e.g., milldams, causeways, reservoirs, small ponds, etc.), have had impacts on the entrainment of sediments, the connectivity between tributaries, main channels, and floodplains, and channel form. As stream restoration efforts increase, how do we restore streams to their ‘natural’ state? Can streams restored to a pre–European settlement condition maintain equilibrium under current land use? Here we examine the impact of post-European settlement changes to a small (432 km²) watershed in southwestern Ohio that is largely representative of rural watersheds in the Midwest. We examine the impact of nineteenth-century milldams, report the results of a 21-year study of nutrient and sediment concentrations in the upper portion of the watershed during a shift from conventional to conservation tillage, and assess the potential impact of the return of beavers on stream sediment and nutrient concentrations. Our objective is to understand how streams have been impacted by humans over the past 250 years, and to identify strategies for ‘restoring’ streams in the Midwest.