Our assessment defined medium-sized streams and rivers as free-flowing streams with an average annual flow of 10 to 6,000 cubic feet/sec (cfs) and sitting at an elevation <=130 meters according to the National Hydrography Dataset (v2). Our Condition Index showed a majority of medium-low gradient streams in the region are impacted by land use, with most of the higher ranking streams in the pine belt. Most targets cannot be reliably assessed with existing data because appropriate spatial datasets are severely limited.