Mountain streams are here defined as channel networks within mountainous regions of the world. This definition encompasses tremendous diversity of physical and biological conditions, as well as history of land use. Human effects on mountain streams may result from activities undertaken within the stream channel that directly alter channel geometry, the dynamics of water and sediment movement, contaminants in the stream, or aquatic and riparian communities. Examples include channelization, construction of grade-control structures or check dams, removal of beavers, and placer mining. Human effects can also result from activities within the watershed that indirectly affect streams by altering the movement of water, sediment, and contaminants into the channel. Deforestation, cropping, grazing, land drainage, and urbanization are among the land uses that indirectly alter stream processes. An overview of the relative intensity of human impacts to mountain streams is provided by a table summarizing human effects on each of the major mountainous regions with respect to five categories: flow regulation, biotic integrity, water pollution, channel alteration, and land use. This table indicates that very few mountains have streams not at least moderately affected by land use. The least affected mountainous regions are those at very high or very low latitudes, although our scientific ignorance of conditions in low-latitude mountains in particular means that streams in these mountains might be more altered than is widely recognized. Four case studies from northern Sweden (arctic region), Colorado Front Range (semiarid temperate region), Swiss Alps (humid temperate region), and Papua New Guinea (humid tropics) are also used to explore in detail the history and effects on rivers of human activities in mountainous regions. The overview and case studies indicate that mountain streams must be managed with particular attention to upstream/downstream connections, hillslope/channel connections, process domains, physical and ecological roles of disturbance, and stream resilience.