We prove the Yau-Tian-Donaldson conjecture for cohomogeneity one manifolds, that is, for projective manifolds equipped with a holomorphic action of a compact Lie group with at least one real hypersurface orbit. Contrary to what seems to be a popular belief, such manifolds do not admit extremal Kähler metrics in all Kähler classes in general. More generally, we prove that for rank one polarized spherical varieties, G-uniform K-stability is equivalent to K-stability with respect to special G-equivariant test configurations. This is furthermore encoded by a single combinatorial condition, checkable in practice. We illustrate on examples and answer along the way a question of Kanemitsu.