One of the basic goals of ecosystem assessment efforts is to describe the impacts of key drivers of change that place the sustained delivery of ecosystem services at risk. Some of these risk factors, such as urban growth and energy extraction, themselves provide important services, and trade-offs must be considered when they compromise other ecosystem benefits. Working towards sustainable landscapes by addressing these trade-offs is one of the great challenges in natural resource management and conservation practice. Here we summarize findings concerning key risk factors from assessment efforts in the Appalachian region.