The ability of a coastal settlement to adapt to climate change is largely dependent upon access to a range of resources, which many coastal towns and small cities lack. Coastal small towns of less than 10,000 are therefore at a significant disadvantage compared to larger settlements when it comes to adaptation. One way to begin to overcome this disadvantage is to compare coastal small towns in order to identify efficiencies and support knowledge sharing. In this article we present and analyse five case studies of coastal small towns: Fuvemeh, Ghana; Kiyú, Uruguay; Hanko, Finland; Lemvig, Denmark; and Nome, Alaska, USA. A number of key outcomes and lessons were identified which highlights the need for a formal network of international coastal small towns to encourage and develop knowledge sharing practices going forward. A further lesson is the importance of using a range of indicators in order to establish the regional/national importance of a town. Basing this solely on population size can result in an erroneous interpretation of the significance (and therefore adaptive capacity) of a coastal small town. Finally, despite many barriers to adaptation in coastal small towns, being small offers some potential advantages, such as the possibility of being able to form a community consensus more easily, using 3D visualisations for adaptation planning, and having managed realignment as a realistic management option. It is imperative that climate change resilience in coastal small towns is increased by focussing on overcoming barriers and developing appropriate adaptation approaches by governments, non-governmental organisations, business, and researchers.