Anthropogenic stressors on large rivers have significantly modified riverine sediment transport. However, the impacts of dredging and sand and gravel (S&G) mining are poorly monitored. We quantify these impacts on the lower Arkansas River, USA, where anthropogenic processes are well documented. The construction of dams caused a 98% reduction in suspended sediment discharge (Qss). Since dam construction, fluvially transported suspended sediment (4.4 ± 0.5 Mtyr−1) and suspended sand discharge (Qsand) (1.1 ± 0.1 Mtyr−1) are of the same order as the dredging rate (1.2 ± 0.1 Mtyr−1) and S&G mining rate (1.7 ± 0.1 Mtyr−1). While the modern sediment deficit on the Arkansas River is smaller than in rivers documented in developing countries, dredging and mining significantly alter the sediment balance in this large river, indicating that extraction management is needed worldwide, especially in developing economies, to improve ecosystem sustainability in large rivers. Plain Language Summary: Large river systems provide many services, including water resources, barge transport, and sand and gravel for construction. Dredging for navigation and sand and gravel (S&G) mining are pervasive in many rivers, but good estimates of these activities are difficult to find. Based on the long‐period records of sediment extraction in the lower Arkansas River (LAR), U.S.A, we show that the river's sediment discharge is of the same order as the sediment extraction rates by dredging and S&G mining. We show that the LAR has a sediment deficit between the cities of Van Buren and Little Rock because the amount of outgoing sediment, including dredging and S&G mining, is greater than the amount of incoming sediment. Similar situations exist and are even worse in large rivers in developing countries, indicating actions are needed to manage sediment extraction to achieve sustainable development of large rivers worldwide. Key Points: Navigation dredging and sand and gravel mining contribute significantly to the sediment discharge decline on the lower Arkansas River (LAR)Engineering sediment extraction is the same order as the magnitude of modern fluvial sediment transport on the LARSediment deficit on the LAR is smaller than in rivers documented in developing countries [ABSTRACT FROM AUTHOR]