Monumental rectangular stone structures called mustatils are an important emerging feature of the Holocene archaeological record of northwestern Arabia. To date, few have been excavated, with available radiocarbon dates suggesting an age range of ca. 5400–4200 BC. Here we present a rigorous spatial analysis to identify the patterning and landscape context of 169 mustatils in the southern and western margins of the Nefud Desert. This included: (1) a systematic survey of satellite imagery to identify mustatils; (2) viewshed analysis to examine location and landscape visibility; (3) a point process model to understand how diverse environmental and landscape variables affect mustatil locations; (4) mark correlation function to assess spatial patterning of mustatils based on their size. Results indicate that mustatil locations are determined most by proximity to water (likely locations of enhanced surface water occurrence under the enhanced humidity of the Mid-Holocene), on east facing slopes, close to rocky areas, at elevations between 880 and 950 masl, and on or near topographic ridges (positive topographic position index). Viewshed analysis showed that mustatils are preferentially located in areas that have good views, but not the best that are available, indicating complex landscape positioning that balances a range of topographic and behavioural factors. Using a rank permutation method with size (length) of mustatils as a proxy for labour mobilization we show that mustatils within clusters are not arranged hierarchically based on size, and were likely built by non-stratified groups of people. Our analyses show that people were choosing multiple factors when deciding where to build mustatils, and that the distribution of mustatils may relate to different groups of people resulting in the construction of complex ritual landscapes. As one of the earliest examples of large-scale monumental stone structure construction in global prehistory, understanding mustatils can enlighten us on human-environment interaction during the Neolithic.