Healthy wetlands benefit our environment and economy in a number of ways, from providing habitat to wildlife and fisheries, to improving water quality, to offering opportunities for recreation. The Clean Water Act requires certain impacts to be compensated, and each year, thousands of acres of wetlands and streams are restored, enhanced, and protected to satisfy the Act’s compensatory mitigation requirements. But the success of compensatory mitigation projects relies on a robust review and approval process that ensures that the protections in federal regulations are implemented in practice on the ground and that compensation projects effectively offset permitted impacts. This report identifies a number of challenges in the implementation of review and approval—from both the agencies’ and providers’ points of view—as well as best practices that may inform future implementation.