After a rapid increase of protected cultivation in the Mediterranean area during recent decades to 143,000 ha of greenhouses, market and production globalization is generating strong competition between growers. Protected cultivation in the Mediterranean region is mostly of vegetable crops (tomato, sweet pepper, cucumber, melon, watermelon, strawberry, squash, green bean, eggplant) with limited amounts of flower (carnation and rose) and ornamental production. Banana is the only fruit tree cultivated in greenhouses in appreciable numbers. The production strategies that were previously based on the use of low-cost greenhouses with very little control of the crop-growing environment, are changing. There is now a general trend to more sophisticated greenhouses with improved climate management, in order to increase product quality. Achieving an economic compromise between the higher costs of improved greenhouses and their increased agronomic production will require different solutions in different countries, according to the local technical and socio-economic conditions. Production costs, product quality and environmental impact appear as the prevailing problems to solve in the Mediterranean greenhouse industry. Focusing on the extremely important and increasing influence of the markets, a global and integrated approach is needed to overcome those problems and to improve the sustainability of the Mediterranean greenhouse industry.