In this paper, the different possibilities and innovations related to sustainable aquaculture in the Mediterranean area are discussed, while different maricultural methods, and the role of Integrated Multi-Trophic Aquaculture (IMTA) in supporting the exploitation of the ocean’s resources, are also reviewed. IMTA, and mariculture in general, when carefully planned, can be suitable for environmental restoration and conservation purposes. Aquaculture, especially mariculture, is a sector that is progressively increasing in parallel with the increase in human needs; however, several problems still affect its development, mainly in relation to the choice of suitable sites, fodder production, and the impact on the surrounding environment. A current challenge that requires suitable solutions is the implementation of IMTA. Unfortunately, some criticisms still affect this approach, mostly concerning the commercialization of new products such as invertebrates and seaweeds, notwithstanding their environmentally friendly character. Regarding the location of a suitable site, mariculture plans are currently displaced from inshore to offshore, with the aim of reducing the competition for space with other human activities carried out within coastal waters. Moreover, in open water, waste loading does not appear to be a problem, but high-energy waters increase maintenance costs. Some suggestions are given for developing sustainable mariculture in the Mediterranean area, where IMTA is in its infancy and where the scarce nutrients that characterize offshore waters are not suitable for the farming of both filter feeder invertebrates and macroalgae. From the perspective of coupling mariculture activity with restoration ecology, the practices suggested in this review concern the implementation of inshore IMTA, creating artificially controlled gardens, as well as offshore mussel farming coupled with artificial reefs, while also hypothesizing the possibility of the use of artificially eutrophized areas.