Threats to coastal wetlands, including sea-level rise and subsidence, led the National Wildlife Refuge (NWR) System to protect over 500,000 hectares of coastal wetlands during the twentieth century, with approximately 20% occurring in the South Atlantic geography. This effort has involved systematic long-term monitoring of changes in marsh elevation using surface elevation tables and marker horizons at 20 sites across 19 NWRs in the southeastern coastal USA. From 2012 to 2021, the rates of change in surface elevation (−9.3 to 7.1 mm/year), accretion (−0.3 to 17.5 mm/year), and net vertical elevation change (−14.3 to 3.1 mm/year) were highly variable among monitoring sites and varied with coastal wetland type (oligohaline marsh, salt marsh, pocosin, or forested wetland), land surface elevation, and estuarine salinity and geomorphology (i.e., tidally influenced or embayed). Of 20 sites included in our study, only six were gaining elevation at a rate that was equal to or greater than the long-term rates of sea-level rise and therefore considered resilient. Only Waccamaw and Currituck NWRs, both located in oligohaline marshes, were gaining elevation at a rate that exceeded sea-level rise by 1 mm/year. These results support the mounting evidence that many coastal wetlands, particularly in the South Atlantic geography of the USA, will undergo ecological transformations in the next several decades. The NWR System and other coastal management entities will need to use strategic decision-making frameworks to identify management actions that can mitigate the loss of coastal wetlands to support the conservation of coastal wetland–dependent and obligate species.