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The water-quality effects of low-density rural land-use activities are understudied but important because of large rural land coverage. We review and synthesize spatially extensive studies of oligotrophic mountain streams in the rural Southern Appalachian Mountains, concluding that rural land-use activities significantly degrade water quality through altered and mostly enhanced landscape-stream connections, despite high forest retention. Some connections (insolation, organic inputs, root-channel interactions, stream-field connectivity, individual landowner discharges) are controlled by near-stream land-use activities, whereas others (reduced nitrogen uptake and cycling, enhanced biological nitrogen fixation, nutrient subsidy, runoff from compacted soils, road runoff delivery) are controlled by basin-wide land use. These connections merge to alter basal resources and shift fish, salamander, and invertebrate assemblages toward species tolerant of higher turbidity and summer temperatures and those more competitive in mesotrophic systems. Rural water quality problems could be mitigated substantially with well-known best management practices, raising socioecological governance questions about best management practice adoption. ; National Science Foundation through the LTER program [DEB-1637522] ; Published version ; Thomas Prebyl created the land cover map. The Coweeta LTER and Coweeta Hydrologic Laboratory technicians, students, and investigators who worked on the synthesized projects are too numerous to name, but we thank all of them for their help. Jason Meador and Kelder Monar from Mainspring Conservation Trust provided input about their conservation programs, such as Shade Your Stream. Fred Benfield, John Maerz, Cathy Pringle, and Paul Bolstad helped conceptualize and frame this synthesis. This work was supported by multiple grants from the National Science Foundation through the LTER program, the last of which was grant no. DEB-1637522. ; Public domain authored by a U.S. government employee