We collected information on 860 stream restoration projects in four states in the southeastern United States—Georgia, Kentucky, North Carolina, and South Carolina—to gain a better understanding of the practice of stream restoration in this area of high aquatic biodiversity and rapid metropolitan expansion. This was completed as a part of the National River Restoration Science Synthesis, with the larger goal of understanding the state of the science of stream restoration. Stream restoration project density, goals, and monitoring rates varied by state, although southeastern monitoring rates were higher than in other parts of the country. North Carolina had the most projects in the Southeast, of which 36% were monitored. In-depth phone interviews with project managers from a random subsample of projects provided insights into the process of stream restoration. Land availability was the most common basis for site prioritization, and 49% of projects involved mitigation. Although 51% of projects were associated with a watershed assessment, only 30% of projects were done as part of a larger plan for the watershed. Projects were monitored using physical (77% of monitored projects), chemical (36%), and biological (86%) variables, although many projects were planned and ultimately evaluated based on public opinion. Our results suggest that stream restoration in the southeastern United States is at an exciting point where better incorporation of a watershed perspective into planning and establishment and evaluation of stated, measurable success criteria for every project could lead to more effective projects.