Low Isles Reef is the most southerly located of 46 coral reef platforms unique to the inner shelf of the northern Great Barrier Reef Province, Australia, which support both sea grass and mangrove growth. Such reefs develop in areas that are influenced by river flood plumes and where interreef sediments are dominated by terrigenous mud. Low Isles Reef has long been a popular tourist destination. Informal reports of decreasing visibility, a decline in scleractinian corals, and increases in soft coral and macroalgae have sparked speculation that agricultural activities in coastal catchments are affecting the reef. Comparison of the modern surface of Low Isles Reef with historical surveys and photographs dating back to 1928 allows quantification of modern sedimentary processes, rates of change, and factors influencing reef development. Results indicate that changes on Low Isles Reef are related to remobilization of coarse sediment during storm events and gradual shoreline retreat associated with rising sea level. Retreat of shingle ramparts and elongate ridges of coral debris toward the reef interior has led to the infilling of subtidal ponds on the reef top, which supported hard coral colonies in 1928. The gradual development of a composite shingle rampart along the windward margin has promoted an increase (∼150%) in the area of the reef top covered by mangroves. On the leeward margin, a decrease in hard corals since 1950 may reflect a rising contribution of organic debris from the expanding mangrove swamp. Results suggest that recent changes on Low Isles Reef can be explained in the context of natural processes. Further study is needed before the effects of agricultural activities in coastal catchments on reef health can be confirmed.