Fatigue crack growth in plate structures is monitored with ultrasonic guided waves generated from piezoelectric transducers. Cracks initiate in the vicinity of fastener holes due to cyclic in-plane loading. Ultrasonic guided waves that are partially obstructed by the fastener holes are investigated. Since fatigue crack growth increases the obstruction, these waves are effective for monitoring fatigue crack growth in a pitch-catch mode. The transmission coefficient (TC), which is defined essentially as the current-to-baseline amplitude ratio, and the transmission coefficient ratio (TCR), which is based on amplitude ratios from a single wave, are signal features used for crack characterization. The TCR is well suited for structural health monitoring. The excellent agreement between experimental results and finite element analysis of wave propagation corroborates the experiments. A sparse array of transducers is shown to effectively monitor a multifastener joint. The approach using obstructed ultrasonic guided waves has strong potential for prognostics-based structural health management due to the linear relationship between crack size and the TC.