Although the impacts of industrial fishing are widely recognized, marine ecosystems are generally considered less threatened by artisanal fisheries. To determine how coral reef fish assemblages and benthic communities are affected by artisanal fishing, we studied six Caribbean islands on which fishing pressure ranged from virtually none in Bonaire, increasing through Saba, Puerto Rico, St Lucia, and Dominica, and reaching very high intensities in Jamaica. Using stationary-point fish counts at 5 m and 15 m depth, we counted and estimated the lengths of all noncryptic, diurnal fish species within replicate 10-m-diameter areas. We estimated percent cover of coral and algae and determined reef structural complexity. From fish numbers and lengths we calculated mean fish biomass per count for the five most commercially important families. Groupers (Serranidae), snappers (Lutjanidae), parrotfish (Scaridae), and surgeonfish (Acanthuridae) showed order-of-magnitude differences in biomass among islands. Biomass fell as fishing pressure increased. Only grunts (Haemulidae) did not follow this pattern. Within families, larger-bodied species decreased as fishing intensified. Coral cover and structural complexity were highest on little-fished islands and lowest on those most fished. By contrast, algal cover was an order of magnitude higher in Jamaica than in Bonaire. These results suggest that following the Caribbean-wide mass mortality of herbivorous sea urchins in 1983–1984 and consequent declines in grazing pressure on reefs, herbivorous fishes have not controlled algae overgrowing corals in heavily fished areas but have restricted growth in lightly fished areas. In summary, differences among islands in the structure of fish and benthic assemblages suggest that intensive artisanal fishing has transformed Caribbean reefs.