Climate change poses significant challenges to coastal cities. Local governments around the world are using various strategies to address sea level rise and coastal flooding. Most of these responses are reactive, developed in an ad hoc manner following a specific event, but there is an increasing recognition of the need for more comprehensive and proactive approaches. Research into the topic reflects practice, with numerous studies of particular locations or strategies providing information in a piecemeal manner lacking in comprehensive evaluations. This paper addresses this gap through a systematic literature review that identifies coastal flooding and sea level rise adaptation practices and evaluates their comparative advantages and disadvantages. The findings identify a major knowledge gap in comparative costs and benefits of alternative adaptation strategies and indicate that coastal climate adaptation needs to be tailored to local characteristics and use a combination of different structural and non-structural measures to be effective.