Globally, freshwater fishes are declining at an alarming rate. Despite much evidence of catastrophic declines, few Australian species are listed as threatened under national legislation. We aim to help redress this by identifying the Australian freshwater fishes that are in the most immediate risk of extinction. For 22 freshwater fishes (identified as highly threatened by experts), we used structured expert elicitation to estimate the probability of extinction in the next ~20 years, and to identify key threats and priority management needs. All but one of the 22 species are small (<150 mm total length), 12 have been formally described only in the last decade, with seven awaiting description. Over 90% of these species were assessed to have a >50% probability of extinction in the next ~20 years. Collectively, the biggest factor contributing to the likelihood of extinction of the freshwater fishes considered is that they occur in small (distributions ≤44 km2), geographically isolated populations, and are threatened by a mix of processes (particularly alien fishes and climate change). Nineteen of these species are unlisted on national legislation, so legislative drivers for recovery actions are largely absent. Research has provided strong direction on how to manage ~35% of known threats to the species considered, and, of these, ~36% of threats have some management underway (although virtually none are at the stage where intervention is no longer required). Increased resourcing, management intervention and social attitudinal change is urgently needed to avert the impending extinction of Australia’s most imperilled freshwater fishes.