Restoration activities intended to improve the condition of streams and rivers are widespread throughout the Upper Midwest, U.S.A. As with other regions, however, little information exists regarding types of activities and their effectiveness. We developed a database of 1,345 stream restoration projects implemented from the years 1970 to 2004 for the states of Michigan, Ohio, and Wisconsin in order to analyze regional trends in goals, presence of monitoring, spatial distribution, size, and cost of river restoration projects. We found that data on individual projects were fragmented across multiple federal, state, and county agencies, as well as nonprofit groups and consulting firms. The most common restoration goals reported for this region were in-stream habitat improvement, bank stabilization, water-quality management, and dam removal. The former two were most common in Michigan and Wisconsin, where salmonid fisheries enhancement appeared to be an important concern, whereas water-quality management was most frequent in Ohio. The most common restoration activities were the use of sand traps and riprap, and other common activities were related to the improvement of fish habitat. The median cost was $12,957 for projects with cost data, and total expenditures since 1990 were estimated at $444 million. Over time, the cost of individual projects has increased, whereas the median size has decreased, suggesting that restoration resources are being spent on smaller, more localized, and more expensive projects. Only 11% of data records indicated that monitoring was performed, and more expensive projects were more likely to be monitored. Standardization of monitoring and record keeping and dissemination of findings are urgently needed to ensure that dollars are well spent and restoration effectiveness is maximized.