Small islands are considered especially vulnerable to natural and anthropogenic hazards. They are stylised flagships of climate change whose multifarious impacts are thought to show straight and immediate effects. This chapter examines the impacts of climate change and environmental pressures and the direct consequences that result for small island communities, including demographic and social change. Adaptation in this context is not merely a question of technological solutions but also a social challenge, as it is framed by various socio-political and economic settings, coping capacities and national-international relations. Resilience and the challenges of sustainable development are discussed and exemplary approaches presented for the sustainable management of future developments.