The electricity sector is dependent on rivers to provide ecosystem services that help regulate excess heat, either through provision of water for evaporative cooling or by conveying, diluting and attenuating waste heat inputs. Reliance on these ecosystem services alters flow and temperature regimes, which impact fish habitat and other aquatic ecosystem services. We demonstrate the contemporary (2000–2010) dependence of the electricity sector on riverine ecosystem services and associated aquatic impacts in the Northeast US, a region with a high density of thermoelectric power plants. We quantify these dynamics using a spatially distributed hydrology and water temperature model (the framework for aquatic modeling in the Earth system), coupled with the thermoelectric power and thermal pollution model. We find that 28.4% of thermoelectric heat production is transferred to rivers, whereas 25.9% is directed to vertical cooling towers. Regionally, only 11.3% of heat transferred to rivers is dissipated to the atmosphere and the rest is delivered to coasts, in part due to the distribution of power plants within the river system. Impacts to the flow regime are minimal, while impacts to the thermal regime include increased river lengths of unsuitable habitats for fish with maximum thermal tolerances of 24.0, 29.0, and 34.0 ◦C in segments downstream of plants by 0.6%, 9.8%, and 53.9%, respectively. Our analysis highlights the interactions among electricity production, cooling technologies, aquatic impacts, and ecosystem services, and can be used to assess the full costs and tradeoffs of electricity production at regional scales.