Mediterranean landscapes are in a state of flux due to the impacts of changing land-use patterns and climate. Fuel–weather interactions determine that large, severe wildfires are increasingly common. Prescribed burning in southern Europe is therefore justified by the need to manage fire-prone vegetation types and maintain cultural landscapes that provide a range of ecosystem services. Prescribed fire has neutral or positive effects on soils and biodiversity, in contrast to wildfires, which can be extremely damaging. However, the limited extent of current applications are unlikely to reduce wildfire hazard or carbon emissions. Adoption of prescribed burning in the Mediterranean region has been slow, uneven, and inconsistent, and its development is constrained by cultural and socioeconomic factors as well as by specific factors related to demography, land use, and landscape structure. Sustainable fire management requires expansion of managers’ ability to use prescribed burning, a varied response to unplanned fires, and modified regulation of burning associated with traditional agricultural land uses.