Support for low-carbon energy and opposition to new large dams encourages global development of small hydropower facilities. This support is manifested in national and international energy and development policies designed to incentivize growth in the small hydropower sector while curtailing large dam construction. However, the preference of small to large dams assumes, without justification, that small hydropower dams entail fewer and less severe environmental and social externalities than large hydropower dams. With the objective to evaluate the validity of this assumption, we investigate cumulative biophysical effects of small (<50 MW) and large hydropower dams in China's Nu River basin, and compare effects normalized per megawatt of power produced. Results reveal that biophysical impacts of small hydropower may exceed those of large hydropower, particularly with regard to habitat and hydrologic change. These results indicate that more comprehensive standards for impact assessment and governance of small hydropower projects may be necessary to encourage low-impact energy development.