In recent years, some iconic rivers have experienced severe drought events, which have led to low water levels and warmer than normal flows. These low and warm flows often lead to negative ecological, economic, and social consequences. To gain a deeper understanding of these impacts, we have been investigating the Yellowstone River, which experienced multiple drought events in recent years, and a major drought event in 2016. The 2016 drought lead to an outbreak of Proliferative Kidney Disease that killed approximately 10,000 fish and resulted in an emergency closure of the 183 miles of the river for 15 days, and some sections were closed longer. We conducted semi-structured, in-depth interviews with outfitters, guides, researchers, and fisheries biologists working within the Yellowstone River Watershed. In our discussions, focused on short and long-term trends, impacts from drought, the disease outbreak and emergency closure, perceived future conditions, and adaptation strategies used to combat recent trends and drought. During our conversations, respondents described recent changes in the Yellowstone River’s runoff cycle, such as earlier runoff, more intense runoff, and increased variability between drought and flood years. Respondents also described the impacts and challenges that have resulted from these changes, such as lower flows and warmer water during the summer months, which heavily impacts fishing quality. Other common themes that emerged from this research were changes in macroinvertebrate abundance and hatch timing and changes in fish distribution, with native Yellowstone Cutthroat Trout decreasing in abundance and moving toward the headwaters and non-native Smallmouth Bass increasing in abundance and moving farther up the Yellowstone River. Respondents, specifically the outfitters and guides, described a variety of adaptation strategies they have employed to combat recent trends and provide quality recreation experiences and maintain their livelihoods. This research provides valuable insight into how recent trends and drought affect the ecological and social components of the Yellowstone River Watershed. It also provides insight into how people coping with these changes to balance and sustain the ecological, economic, and social health of a watershed.