The term "environmental flows" describes the quantities, quality, and patterns of water flows required to sustain freshwater and estuarine ecosystems and the ecosystem services they provide. Environmental flows may be achieved in a number of different ways, most of which are based on either (1) limiting alterations from the natural flow baseline to maintain biodiversity and ecological integrity or (2) designing flow regimes to achieve specific ecological and ecosystem service outcomes. We argue that the former practice is more applicable to natural and semi-natural rivers where the primary objective and opportunity is ecological conservation. The latter “designer” approach is better suited to modified and managed rivers where return to natural conditions is no longer feasible and the objective is to maximize natural capital as well as support economic growth, recreation, or cultural history. This permits elements of ecosystem design and adaptation to environmental change. In a future characterized by altered climates and intensive regulation, where hybrid and novel aquatic ecosystems predominate, the designer approach may be the only feasible option. This conclusion stems from a lack of natural ecosystems from which to draw analogs and the need to support broader socioeconomic benefits and valuable configurations of natural and social capital.