Our current pattern of urban growth is simply unsustainable from any perspective. This chapter is a discussion of possible sustainable pathways for our cities and regions. We can no longer separate cities and regions in an urban world: they are now inextricably linked, one expanding into and dependent upon the other. The impact of climate change on the health and well-being of urban communities remains central. All these factors must be the considered in developing sustainable pathways for an urban future. Seven sustainable pathways are put forward as a contribution to finding better solutions. People, place and landscape are core themes as well as community engagement, accountability and transparency in urban governance. The seven sustainable pathways combine to make positive strategies for more sustainable cities and regions. On their own they can make a difference, but together they can transform our urban future. Innovative platforms for tracking progress on implementing sustainable development over the long term are highlighted. Finally, as the global population increases from 7 billion to nearly 10 billion by 2050, the development of stronger urban and regional planning frameworks is no longer a question but a necessity if we are to have a hope of a more sustainable urban future. It will require embedding environmental sustainability through every urban decision (region, city and neighbourhood) and most importantly city-region governance and innovative platforms to make it happen (short and long term). This chapter is a guide for urban decision makers and community leaders involved in determining urban and regional futures.