Coral reefs are the most diverse ecosystem in the sea. Throughout the world they are being over-fished, polluted and destroyed, placing biodiversity at risk. To date, much of the concern over biodiversity loss has centred on local losses and the possibility of global extinction has largely been discounted. However, recent research has shown that 24% of reef fish species have restricted ranges (< 800 000 km2), with 9% highly restricted (< 50 000 km2). Restricted-range species are thought to face a greater risk of extinction than more widespread species since local impacts could cause global loss. We searched for information on status in the wild and characteristics of 397 restricted-range reef fish species. Fish body size, habitat requirements and usefulness to people were compared with those of a taxonomically-matched sample of more widespread species. We found that on average species with restricted ranges were significantly smaller (mean total length 19.1 cm versus 24.4 cm), tended to have narrower habitat requirements and were less used by people. Greater habitat specificity will tend to increase extinction risk while, if real, more limited usefulness (equivalent to exploitation) may reduce risk. Fifty-eight percent of restricted-range species were considered common/abundant in the wild and 42% uncommon/rare. Population status and threats to 319 species for which data were available were assessed according to the categories and criteria of the IUCN red list of threatened animals. A number of species were found to be rare, were exploited and had highly restricted ranges overlapping areas where reef degradation is particularly severe, placing them at a high risk of extinction. Five species were listed as Critically Endangered, two of them possibly already extinct in the wild, one as Endangered and 172 as Vulnerable. A further 126 species fell into Lower Risk categories and 11 were considered Data Deficient. Given the intensity of impacts to reefs, the broad geographical areas affected and the large numbers of restricted-range species, global extinctions seem likely. Urgent management action is now crucial for the survival of several species of reef fishes.