Improved access to markets by small-scale fisheries (SSF), as called by Sustainable Development Goal 14b and other global and Mediterranean policy documents, is impeded by the existing organisation of value chains and market structures, which are typically antagonistic to the nature of SSF. This article analyses the markets in the Mediterranean to map the drivers and feedback loops that keep fisheries in an unsustainable trajectory and reviews the key innovations in support of a socially, economically and environmentally sustainable small-scale fishing sector. We show how the current market is dominated by lack of product traceability and underappreciation of the inherent value of SSF products (e.g. local production, freshness, season dependence, quantitatively and culinary varied nature). In addition, due to a lack of organisation and the capacity to act, small-scale fishers are poised to have little to no influence over the price. In what we conceptualise as a response to the negative effects of existing market structures, we identify and classify initiatives that add value to SSF products, but not exclusively. These are the shortening of the value chain, innovation in the distribution channel, diversification in the type of product offered, promotion and education regarding SSF products, label and brand development and the empowerment of SSF communities through improved leadership, ownership, cooperation and coordination. We provide examples of these activities and propose the key types of intervention at various levels of governance to accelerate and capitalise on them in order to accomplish policy goals and achieve a better status of both the oceans and the fishers.