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To assess the potential exposure of aquatic ecosystems to active pharmaceutical ingredients, the authors conducted a national-scale, probability-based statistical survey of the occurrence of these compounds in surface waters of the United States. The survey included 182 sampling sites and targeted rivers with close proximity to urban areas. The 46 analytes reported represent many classes of active pharmaceutical ingredients (APIs), including antibiotics, diuretics, antihypertensives, anticonvulsants, and antidepressants. Of the 46 analytes, 37 were detected in at least 1 sampling location. Sulfamethoxazole (an antibiotic) was the most frequently detected compound, being measured in 141 of the 182 surface waters surveyed at concentrations ranging up to 570 ng/L. Ten of the compounds were detected in 20% or more of the sampling sites. Weighted means of the analytical measurements are used with the statistical survey design and analysis to provide national estimates of the extent of contamination for these APIs in the nation's urban rivers. Published 2015 Wiley Periodicals, Inc. on behalf of SETAC. This article is a US Government work and as such, is in the public domain in the United States of America.