The analysis shifts from a European to a regional perspective, focusing on three critical and interconnected processes that define contemporary Mediterranean insularity. Firstly, it examines the topic of migration and human mobility by analyzing the multifaceted role of islands as borders, hotspots and containment zones, as well as spaces of cultural hybridization. Secondly, it addresses the crisis in small-scale fisheries by discussing its structural causes and potential integrated solutions, such as ‘pescatourism’. Thirdly, it analyses the pervasive impact of island tourism, focusing particularly on seasonality, overtourism and challenges to resources management. Finally, the chapter discusses the crucial role of islands in environmental governance, particularly through Marine Protected Areas (MPAs) and their presence in transnational programs such as Interreg Euro-MED. This establishes islands as pivotal territories in addressing Mediterranean future geographical challenges.