Although more than one fifth of the world’s population now lives in metropolitan regions with populations of more than one million, few responsible institutions have been introduced to assist in their effective governance or planning. Worldwide, the administration and planning of most metropolitan regions relies on voluntary cooperation between local governments and/or provision of metropolitan planning and services by central governments. These systems suffer from lack of coordination, transparency, integrated implementation or demonstrated capacity to achieve sustainable settlement forms. Alternative systems, including representative metropolitan administrations and regional governments, have achieved some significant successes in Europe and North America. In UK and parts of Netherlands, indirectly elected regional assemblies are now responsible for strategic planning and in British Columbia they also undertake provision and coordination of some important services. Composed of members drawn from constituent local councils, they have good levels of acceptance from local and central governments. In Italy and Oregon, regional governments have strengthened social, economic and political life by bringing government and planning closer to regional and local communities, through representative and participatory public involvement. The paper argues that while metropolitan regions require coordinated growth management strategies, non-metropolitan local governments also need to achieve economies of scale within regional alliances to meet challenges of population decline and economic stagnation Metroplitan administration and planning can thus best be tackled within a coherent regional system. The paper concludes by developing the general features of an approach to regional governance that could be applied equally to metropolitan and non-metroplitan regions in both unitary and federal nations.