Despite repeated warnings of 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 decrease 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 new antibiotics so desperately needed? What incentives could revitalize the antibiotic pipeline? What role can government and others play to support drug companies? And if we were to design an ideal system for development of new antibiotics while minimizing the development of resistance, what would that look like?