The aim of this study was to assess the effects of fatigue on decision making and goal shooting skill in water polo. Fourteen junior elite male players (age 17.2 ± 0.5 years; mass 84.2 ± 7.6 kg; height 1.85 ± 0.05 m) completed four sets of eight repetitions of an approximately 18 s maximal water polo specific drill. Progressively declining rest ratios for each successive set of the drill were employed to induce increasing fatigue and reflect the demands of match-play. A video-based temporally occluded decision-making task (verbalized response to various tactical situations) or goal shooting skill test (qualitative and quantitative analysis of goal shooting) was performed after each set. Heart rate, rating of perceived exertion (RPE) and blood lactate concentration were recorded. Heart rate (159 ± 12, 168 ± 13, 176 ± 12, 181 ± 12 Deats min^-1; P < 0.001) and RPE (13.1 ± 2.2, 15.5 ± 1.7, 17.3 ± 1.6, 19.1 ± 1.1; P < 0.001) increased with declining rest ratios. At very high fatigue, decision-making accuracy was 18.0 ± 21.8% better than at low fatigue (P = 0.008). Shooting accuracy and velocity were unaffected by incremental fatigue; however, skill proficiency (technique) decreased by 43 ± 24% between the pre-test and high-fatigue conditions (P < 0.001). In conclusion, incremental increases in fatigue differentially influenced decision making (improved) relative to the technical performance (declined), accuracy and speed of the ball (unchanged) of a water polo goal shot.