Throughout the world, areas have been reserved for their exceptional environmental values, such as high biodiversity. Financial, political and community support for these protected areas is often dependent on visitation by nature-based tourists. This visitation inevitably creates environmental impacts, such as the construction and maintenance of roads, tracks and trails; trampling of vegetation and erosion of soils; and propagation of disturbance of resilient species, such as weeds. This creates tension between the conservation of environmental values and visitation. This review examines some of the main features of environmental impacts by nature-based tourists through a discussion of observational and manipulative studies. It explores the disturbance context and unravels the management implications of detecting impacts and understanding their causes. Regulation of access to visitor areas is a typical management response, qualified by the mode of access (e.g., vehicular, ambulatory). Managing access and associated impacts are reviewed in relation to roads, tracks and trails; wildlife viewing; and accommodations. Responses to visitor impacts, such as environmental education and sustainable tour experiences are explored. The review concludes with ten recommendations for further research in order to better resolve the tension between nature conservation and nature-based tourism.