Coastal zones, the world's most densely populated regions, are increasingly threatened by climate change stressors — rising and warming seas, intensifying storms and droughts, and acidifying oceans. Although coastal zones have been affected by local human activities for centuries, how local human impacts and climate change stressors may interact to jeopardize coastal ecosystems remains poorly understood. Here we provide a review on interactions between climate change and local human impacts (e.g., interactions between sea level rise and anthropogenic land subsidence, which are forcing Indonesia to relocate its capital city) in the coastal realm. We highlight how these interactions can impair and, at times, decimate a variety of coastal ecosystems, and examine how understanding and incorporating these interactions can reshape theory on climate change impacts and ecological resilience. We further discuss implications of interactions between climate change and local human impacts for coastal conservation and elucidate the context when and where local conservation is more likely to buffer the impacts of climate change, attempting to help reconcile the growing debate about whether to shift much of the investment in local conservation to global CO2 emission reductions. Our review underscores that an enhanced understanding of interactions between climate change and local human impacts is of profound importance to improving predictions of climate change impacts, devising climate-smart conservation actions, and helping enhance adaption of coastal societies to climate change in the Anthropocene.