Conserving and managing global natural capital requires an understanding of the complexity of flows of ecosystem services across geographic boundaries. Failing to understand and to incorporate these flows into national and international ecosystem assessments leads to incomplete and potentially skewed conclusions, impairing society's ability to identify sustainable management and policy choices. In this paper, we synthesise existing knowledge and develop a conceptual framework for analysing interregional ecosystem service flows. We synthesise the types of such flows, the characteristics of sending and receiving socio-ecological systems, and the impacts of ecosystem service flows on interregional sustainability. Using four cases (trade of certified coffee, migration of northern pintails, flood protection in the Danube watershed, and information on giant pandas), we test the conceptual framework and show how an enhanced understanding of interregional telecouplings in socio-ecological systems can inform ecosystem service-based decision making and governance with respect to sustainability goals.