River rehabilitation and ecological engineering are becoming critical issues for improving river status when ecological habitats and connectivity have been altered by human pressures. Amongst the range of existing rehabilitation options, some specifically focus on rebuilding fluvial forms and improving physical processes. The aim of this contribution is to illustrate how geomorphological expertise and process-based thinking contribute to river rehabilitation success. This semantic contribution is intended to feed the rehabilitation debate, particularly concerning the design of actions and the proposed references for monitoring target reaches and evaluating rehabilitation effects empirically. This article is also based on lessons learned from practical cases, mainly in gravel-bed rivers. Geomorphic understanding is needed at a local level to achieve an adequate diagnosis of river functioning, estimate human impacts and potential remnant river responsiveness, and to assess the gains and risks from rehabilitation, as well as to appraise success or failure through several pre- and post-project assessment strategies. Geomorphological studies can also be upscaled in a top-down manner (from high-order controls to small-scale processes, understanding detailed processes in their regional or basin-wide context), providing large-scale information at the regional, national, or even global level, information that can be used to diagnose the health of riverscapes in relation to local site-specific contexts. As such, geomorphological studies support strategic planning and prioritization of rehabilitation works according to specific contexts and river responsiveness, so as to move from opportunistic to objective-driven strategies.