Amid signs that estuarine ecosystems are increasingly degraded and may reach new thresholds of irreversible decline, restoration ecologists and coastal managers world-wide have joined the debate on how best to reverse the trends of the recent past.2Any meaningful effort at reversal must, however, recognize that humans are an integral part of the landscape, particularly in urban estuarine settings, and that natural resource baselines have permanently shifted. Consequently, the human dimensions component of sustainability science has become an integral part of ecological restoration/rehabilitation planning, and new schema evolving out of coastal governance and management are not only increasingly underpinned by transdisciplinary science, but are beginning to address the sacrifices and compromises that will be necessary to achieve a balance between human uses of estuarine resources and biotic integrity.3The challenge will be to preserve ecosystem functions and use natural capital at a variety of scales while simultaneously sustaining local communities, social and formal institutions, economies and markets at the highest levels of system organization.4How we manage competing uses while at the same time preserving the dynamic properties and resilience of ecosystems will be a significant test. Current ecosystem management and restoration goals appear to be weighted towards returning and/or preserving natural functions decoupled from system reliability. In human-dominated systems, however, they should be redirected towards goals and mandates to rehabilitate the functions associated with service reliability.5Synthesis and applications. If we are to avoid the harsh lessons of the utilization of terrestrial resources, scientists, practitioners and coastal managers will have to find a middle ground between continued economic growth and preservation/conservation of coastal resources. Success will require broad acceptance that humans are as coastally dependent as any part of the biota, and that future plans for managing, restoring and/or rehabilitating estuarine ecosystems must recognize that humans occupy the highest level of the ecological–cultural landscape.