Declining fall flows are limiting the ability of the Cosumnes River to support large fall runs of Chinook salmon. Management scenarios linking surface water and groundwater alternatives to provide sufficient fall flows are examined using groundwater flow and channel routing models. Results show that groundwater overdraft in the basin has converted the river to a predominantly losing stream, practically eliminating base flows. Management alternatives to increase net recharge (for example, pumping reductions) were examined along with surface water augmentation options. Using a minimum depth standard for fish passage, average surface water flow deficits were computed for the migration period of Chinook salmon. Groundwater deficits were evaluated by comparing simulated current groundwater conditions with conditions under various scenarios. Increases in net recharge on the order of 200 to 300 million m3/year would be required to reconnect the regional aquifer with the channel and in turn reestablish perennial base flows. Options that combine surface water augmentation with groundwater management are most likely to ensure sufficient river flows in the short term and to support long-term restoration of regional groundwater levels.