Pacific Lamprey (Entosphenus tridentatus) is an anadromous fish that provides many ecosystem services and is important to Native American tribes who harvest them for cultural uses. The largest harvest of adult Pacific Lamprey in North America occurs at Willamette Falls (“WF”; Oregon, USA). Lamprey have experienced conservation problems for decades and harvest numbers at WF have plummeted ~33‐fold, from a maximum of >500,000 during 1946 to an average of ~16,000 per year during 1969 – 1999. Recent harvest has dropped to <6,000 lamprey per year during 2000 – 2021. However, existing conservation plans do not provide a historical perspective on the lamprey harvest at WF and the cumulative threats to them in the Willamette basin that likely caused harvest reductions. Land development, river impoundment, and water pollution coincided with significant decreases in lamprey harvest at WF. These (and other) threats have resulted in reduced habitat for larval lamprey in the basin, and thus a reduction in the pheromones they release (which attract adults). Conservation plans do not identify specific, basin‐wide goals to increase the number of lamprey in general and to provide more lamprey for harvest in particular. Therefore, in this review paper we provide a conservation perspective on three topics to increase and monitor lamprey abundance at WF. We (1) provide an up‐to‐date history of the lamprey harvest and its regulation at WF, (2) recommend addressing the lack of basin‐wide, lamprey‐specific passage and habitat restoration to improve the quantity and quality of lamprey spawning and rearing habitats, and (3) identify research needs for monitoring the population(s) of lamprey at WF. We conclude that lamprey‐specific passage and habitat restoration throughout the Willamette basin above WF is necessary to bolster abundance.