The classification of a hydropower scheme as run-of-the-river (or run-of-river; ROR) evokes an image of a low-impact installation; however, examination of eight case studies worldwide shows that substantial negative societal and ecological impacts are tied to them, albeit in somewhat different ways. We conclude that ROR dams not only potentially displace communities, disrupt livelihoods, and degrade environments in surrounding areas, but they also divert water from areas of need, impact aquatic ecology through habitat destruction and disruption of fish migrations, emit non-trivial amounts of greenhouse gases over the lifespan of the project, and disrupt streamflow in downstream river sections. While these negative impacts vary on a case-by-case basis, medium and large ROR dams consistently have multiple and cumulative impacts, even when not having appreciable reservoirs. We contend that many impactful dams do not qualify as low-impact ROR projects, despite being defined as such. Such mislabeling is facilitated in part by the ambiguous definition of the term, which risks the ROR concept being used by proponents of impactful structures to downplay their negative effects and thus mislead the public or gain status, including within the Clean Development Mechanism in relation to mitigating climate change.