Ecosystems benefit people in many ways, but these contributions do not appear in traditional national or corporate accounts so are often left out of policy- and decision-making. Ecosystem accounts, as formalized by the System of Environmental-Economic Accounting Experimental Ecosystem Accounts (SEEA EEA), track the extent and condition of ecosystem assets and the flows of ecosystem services they provide to people and the economy. While ecosystem accounts have been compiled in a number of countries, there have been few attempts to develop them for the United States. We explore the potential for ecosystem accounting in the United States by compiling ecosystem condition and ecosystem services supply and use accounts for a ten-state region in the Southeast. The pilot accounts include information related to air quality, water quality, biodiversity, carbon storage, recreation, and pollination for selected years from 2001 to 2015. Results from our pilot accounts illustrate how ecosystem accounts information can contribute to policy and decision-making. Using an example for Atlanta, we also show how ecosystem accounts can be considered alongside other SEEA accounts, such as land and water accounts, to give a more complete picture of a local area’s environmental-economic status. The process by which we determined where to place metrics within the accounting framework, which was strongly informed by the National Ecosystem Services Classification System (NESCS), can provide practical guidance for future ecosystem accounts in the U.S. and other countries, and for expanding the scope of U.S. ecosystem accounts. Finally, we identify knowledge and data gaps that limit the inclusion of certain ecosystem services in the accounts and suggest future research and data collection that can close these gaps and improve future ecosystem accounts in the U.S.