Riverine thermal regimes are an important but overlooked component of environmental flows. Dams and other human activities can strongly modify the natural thermal regime of rivers by altering water temperatures, often decreasing temperatures downstream. Five key challenges to incorporating thermal regimes into environmental flow assessments are: 1) improving understanding of natural thermal variability, 2) quantifying the degree dams alter thermal regimes, 3) relating thermal changes to ecological impacts, 4) developing thermal criteria, and 5) implementing management strategies to restore thermal conditions.