The actively flowing waters of streams and rivers remain in close contact with surrounding off-channel and subsurface environments. These hydrologic linkages between relatively fast flowing channel waters, with more slowly flowing waters off-channel and in the subsurface, are collectively referred to as hydrologic exchange flows (HEFs). HEFs include surface exchange with a channel’s marginal areas and subsurface flow through the streambed (hyporheic flow), as well as storm-driven bank storage and overbank flows onto floodplains. HEFs are important, not only for storing water and attenuating flood peaks, but also for their role in influencing water conservation, water quality improvement, and related outcomes for ecological values and services of aquatic ecosystems. Biogeochemical opportunities for chemical transformations are increased by HEFs as a result of the prolonged contact between flowing waters and geochemically and microbially active surfaces of sediments and vegetation. Chemical processing is intensified and water quality is often improved by removal of excess nutrients, metals, and organic contaminants from flowing waters. HEFs also are important regulators of organic matter decomposition, nutrient recycling, and stream metabolism that helps establish a balanced and resilient aquatic food web. The shallow and protected storage zones associated with HEFs support nursery and feeding areas for aquatic organisms that sustain aquatic biological diversity. Understanding of these varied roles for HEFs has been driven by the related disciplines of stream ecology, fluvial geomorphology, surface-water hydraulics, and groundwater hydrology. A current research emphasis is on the role that HEFs play in altered flow regimes, including restoration to achieve diverse goals, such as expanding aquatic habitats and managing dissolved and suspended river loads to reduce over-fertilization of coastal waters and offset wetland loss. New integrative concepts and models are emerging (eg, hydrologic connectivity) that emphasize HEF functions in river corridors over a wide range of spatial and temporal scales.