As water-based recreation demand grows, it comes with the need for recreation site managers to consider how to best satisfy different stakeholder groups. This study sought to measure importance performance analysis (IPA) and place attachment among users of stream access sites in southeast Appalachia and segment the results between residents and tourists, analyzing the results for potential differences between the two groups. No prior IPA has been conducted among stream access site visitors segmenting the results between residents and tourists. Additionally, no place attachment scale consisting of three three-item dimensions has been employed among water-based recreationists comparing residents and tourists concurrently. Data was collected for this study using an intercept survey method across 10 different Tennessee Valley Authority stream access sites in Georgia and North Carolina. Results show that residents exhibit higher levels of satisfaction with these sites and higher levels of place attachment when compared with tourists. Significant differences were found among residents and tourists regarding 10 of 23 importance attributes, 10 of 23 performance attributes. Specifically, both groups expressed dissatisfaction with bathrooms, and tourists expressed greater dissatisfaction with information accessibility such as online information and river maps. Residents, meanwhile, expressed higher levels of attachment in all three place attachment dimensions including place identity, place dependence, and nature bonding. This study supports the benefit for segmentation between residents and tourists in IPA and place attachment analysis. Implications include management aims that can address both residents’ and tourists’ perceptions while taking into account how these groups bond with the stream access sites that they visit.