There have been at least two major compilations of research on the topic of freshwater inflow. There was a symposium convened in 1980 in San Antonio, Texas to identify the issues regarding “Freshwater Inflow to Estuaries” (Cross and Williams 1981). The goal of the symposium was to identify potential solutions and recommendations to deal with the issues of altered inflow regimes. A second symposium was convened in 2001 in St. Pete Beach, Florida entitled “Freshwater Inflow: Science, Policy and Management” (Montagna et al. 2002a). The second symposium is notable because in the intervening 21 years, many agencies began to implement freshwater inflow rules and regulations, performed research on the effects of the rules, and even attempted to restore estuaries where inflow was reduced. One important aspect of nearly all the minimum freshwater inflow rules is that they are amenable to adaptive management. Results from ongoing monitoring and assessment programs are used to modify and optimize the operating decisions. This is very important. Following is a brief summary of case studies in Texas, Florida, California, Australia, and South Africa.