This paper presents a general review of the distribution of mesophotic coral ecosystems (MCEs) in relationship to geomorphology in US waters. It was specifically concerned with the depth range of 30–100 m, where more than 186,000 km2 of potential seafloor area was identified within the US Gulf of Mexico/Florida, Caribbean, and main Hawaiian Islands. The geomorphology of MCEs was largely inherited from a variety of pre-existing structures of highly diverse origins, which, in combination with environmental stress and physical controls, restrict the distribution of MCEs. Sea-level history, along with depositional and erosional processes, played an integral role in formation of MCE settings. However, mapping the distribution of both potential MCE topography/substrate and existing MCE habitat is only beginning. Mapping techniques pertinent to understanding morphology and MCE distributions are discussed throughout this paper. Future investigations need to consider more cost-effective and remote methods (such as autonomous underwater vehicles (AUVs) and acoustics) in order to assess the distribution and extent of MCE habitat. Some understanding of the history of known MCEs through coring studies would help understand their initiation and response to environmental change over time, essential for assessing how they may be impacted by future environmental change.