Mapping, monitoring, and management of coral reefs of Florida, the Flower Garden Banks National Marine Sanctuary (FGBNMS) northwestern Gulf of Mexico, Puerto Rico, U.S. Virgin Islands and Navassa have all improved with increased awareness and funding from the Government of the USA. Quantitative baseline surveys of coral reef communities have been completed in Puerto Rico at three current or proposed Natural Reserves. Monitoring is demonstrating trends in reef community health and structure in other sensitive coastal areas. The Tres Palmas Marine Reserve has been designated recently, and existing MPAs and revisions to fishing laws were evaluated based on these results. In the U.S. Virgin Islands (USVI), the Buck Island Reef National Monument has been expanded and a new park, the St. Croix East End Marine Park established in 2003. The monitoring programs in the USVI are now detecting changes in fish and coral community structure in and around the managed areas with a specific focus on elkhorn coral stands. Monitoring of water quality, reef diversity, growth, and populations of dominant fish and benthic organisms in Flower Garden Banks, Stetson Bank, and Navassa has assisted in evaluating impacts of climate change, tropical storms, fishing, and tourism pressures. An expanded Florida monitoring program is now completing the first integrated assessment of the reefs northwards from the Florida Keys. It is hoped that this increased attention to coral reef issues will continue, and that advances in the understanding of how coral reef ecosystems respond to anthropogenic stresses will result in better management plans that protect coastal resources by reducing those stresses. However, an improved understanding of the relative importance of how stresses contribute to or cause coral decline is needed. There is a need also to understand the linkages between water flows and the functioning of coral reef ecosystems. It is essential to strengthen cross-boundary and cross-jurisdictional agreements to facilitate ecosystem-based management and information and technology transfer.