This paper presents a critical comparison of the traditional strength criteria and the modern plastic flow criteria used in the structural design and integrity assessment of pressure vessels. This includes (1) a brief review of the traditional strength criteria used in the ASME Boiler and Pressure Vessel (B&PV) Code, (2) a discussion of the shortcomings of the traditional strength criteria when used to predict the burst pressure of pressure vessels, (3) an analysis of challenges, technical gaps, and basic needs to improve the traditional strength criteria, (4) a comparison of strength theories and plasticity theories for ductile materials, (5) an evaluation of available plastic flow criteria and their drawbacks in prediction of burst pressure of pressure vessels, (6) a description of a newly developed multiaxial yield criterion and its application to pressure vessels, and (7) a demonstration of experimental validation of the new plastic flow criterion when used to predict the burst pressure of thin-wall pressure vessels. Finally, recommendations are made for further study to improve the traditional strength design criteria and to facilitate utilization of the modern plastic flow criteria for pressure vessel design and analysis.