This paper on transit-oriented development (TOD) is from the proceedings of 14th international Conference on Urban Transport and the Environment in the 21st Century, which was held in Malta in 2008. The authors focus on strategies that can integrate land use and transportation in small island states, such as Malta. They describe the Leipzig Charter (2007), which is currently consolidating the focus on the implementation of urban development and planning based on integrated approaches to create sustainable cities and communities. They use the island state of Malta to demonstrate how bold decisions and changes in the realm of strategic and integrated planning in the long term are needed. The paper reviews the social and economic impacts of Malta joining the European Union in 2004, which resulted in an increase in investments and strengthening of the economy. The authors stress that the population density of Malta is by far the highest in the EU and is one of the highest in the world, and Malta has the most unsustainable fleet of private cars ranking 4th in the EU for the highest number of cars per 1,000 people. They conclude with a discussion of TOD and how it can respond to the exigencies of a small island state, particularly with a focus on smart growth and the promotion of environmentally-friendly cities.