Rivers around the world are being regulated by dams to accommodate the needs of a rapidly growing global population. These regulatory efforts usually oppose the natural tendency of rivers to flood, move sediment, and migrate. Although an economic benefit, river regulation has come at unforeseen and unevaluated cumulative ecological costs. Historic and contemporary approaches to remedy environmental losses have largely ignored hydrologic, geomorphic, and biotic processes that form and maintain healthy alluvial river ecosystems. Several commonly known concepts that govern how alluvial channels work have been compiled into a set of "attributes" for alluvial river integrity. These attributes provide a minimum checklist of critical geomorphic and ecological processes derived from field observation and experimentation, a set of hypotheses to chart and evaluate strategies for restoring and preserving alluvial river ecosystems. They can guide how to (i) restore alluvial processes below an existing dam without necessarily resorting to extreme measures such as demolishing one, and (ii) preserve alluvial river integrity below proposed dams. Once altered by dam construction, a regulated alluvial river will never function as before. But a scaled-down morphology could retain much of a river's original integrity if key processes addressed in the attributes are explicitly provided. Although such a restoration strategy is an experiment, it may be the most practical solution for recovering regulated alluvial river ecosystems and the species that inhabit them. Preservation or restoration of the alluvial river attributes is a logical policy direction for river management in the future.