In reflecting on the human domination of our planet in the Anthropocene, some have argued that concrete is among the most destructive materials created by humans. Here we explore this idea, specifically in the context of what we consider “the concrete conquest of aquatic ecosystems.” The ubiquitous use of concrete in transportation and building infrastructure has contributed to alterations in freshwater and coastal marine systems. Yet, in some cases, there are no appropriate alternative building materials such that concrete itself is confounded by its application. For example, as the foundation for most dams, concrete fragments rivers and channelizes streams, often creating unnatural systems, yet dams are necessary for hydropower generation and flood control with few alternative materials for construction. In riparian and coastal environments, concrete harbours and inland canal systems are often used to address erosion or reclaim areas for human development. Even when removed (e.g., dam removal, naturalization of shorelines), concrete dust is a major aquatic pollutant. Instances do exist, however, where concrete has been used to benefit aquatic ecosystems – such as the installation of fish passage facilities at barriers or the development of fish-friendly culverts – though even then, there is a movement towards nature-like fishways that avoid the use of harmful materials like concrete. There are also opportunities to achieve conservation gains in the development of seawalls that include more natural and complex features to benefit biota and allow for essential biogeochemical processes to occur in aquatic environments. There have been several innovations in recent years that increase the permeability of concrete, however these have limited application in an aquatic context (e.g., not relevant to dam construction or erosion control but may be relevant in stormwater management systems). We provide a brief overview of the history of concrete, discuss some of the direct and indirect effects of concrete on aquatic ecosystems, and encourage planners, engineers, developers, and regulators to work collaboratively to explore alternatives to concrete which benefit aquatic ecosystems and the services they offer. The status quo of concrete being the default construction material is failing aquatic ecosystems, so we recommend that efforts are made to explore alternative materials and if concrete must be used, to increase structural complexity to benefit biodiversity.