Despite repeated warnings about the worldwide growth of antimicrobial resistance, the antibiotic pipeline has failed to adequately grow to deliver new options for patients. As the number of drug companies working on antibacterial drugs decreases and small companies with approved products go bankrupt, it is clear that the market is not working as it should. What can be done to create a sustainable market for desperately needed new antibiotics? What incentives could revitalize the antibiotic pipeline? What role can the government and others play to support drug companies? If we were to design an ideal system for the development of new antibiotics while minimizing the development of resistance, what would that look like?