Hundreds of millions of dollars per year are spent on river restoration in the Pacific Northwest (PNW), but little is known about the effectiveness of this effort. To help address this gap, we analyzed a database containing 23,000 projects at 35,000 locations in the region. We selected a subset of these projects for interviews using a survey instrument developed by a national team of scientists. In total, 47 project contacts in the PNW were interviewed to learn from the individuals directly involved in restoration. At least one-third of the projects surveyed (34%) did not conduct sufficient monitoring to evaluate effectiveness. More than two-thirds (70%) of all respondents reported their projects were successful, but 43% either have no success criteria or are unaware of any criteria for their project. Although almost two-thirds (66%) of respondents anticipate a need for ongoing project maintenance, less than half (43%) have maintenance funds available. These findings suggest that establishing a connection between effectiveness monitoring and project implementation is not a usual component of project design. Consequently, we can only assess the benefits in a few isolated projects and cannot quantify the cumulative benefits of restoration on a larger scale. These findings highlight the need for (1) planning prior to implementation of restoration projects that accounts for monitoring design; (2) coordinated effectiveness monitoring to assess cumulative effects of restoration; and (3) management and maintenance of projects based on real measures of project performance.