The Caribbean and Western Atlantic region hosts one of the world’s most diverse geopolitical regions and a unique marine biota distinct from tropical seas in the Pacific and Indian Oceans. While this region varies in human population density, GDP and wealth, coral reefs, and their associated ecosystem services, are central to people’s livelihoods. Unfortunately, the region’s reefs have experienced extensive degradation over the last several decades. This degradation has been attributed to a combination of disease, overfishing, and multiple pressures from other human activities. Furthermore, the Caribbean region has experienced rapid ocean warming and acidification as a result of climate change that will continue and accelerate throughout the 21st century. It is evident that these changes will pose increasing threats to Caribbean reefs unless imminent actions are taken at the local, regional and global scale. Active management is required to sustain Caribbean reefs and increase their resilience to recover from acute stress events. Here, we propose local and regional solutions to halt and reverse Caribbean coral reef degradation under ongoing ocean warming and acidification. Because the Caribbean has already experienced high coral reef degradation, we suggest that this region may be suitable for more aggressive interventions than might be suitable for other regions. Solutions with direct ecological benefits highlighted here build on existing knowledge of factors that can contribute to reef restoration and increased resilience in the Caribbean: (1) management of water quality, (2) reduction of unsustainable fishing practices, (3) application of ecological engineering, and (4) implementing marine spatial planning. Complementary socioeconomic and governance solutions include: (1) increasing communication and leveraging resources through the establishment of a regional reef secretariat, (2) incorporating reef health and sustainability goals into the blue economy plans for the region, and (3) initiating a reef labelling program to incentivize corporate partnerships for reef restoration and protection to sustain overall reef health in the region.