The Red Sea is one of the warmest and saltiest seas of the world. Water exchanges occur only in the south, and there is moderate nutrient variability at macroecological scales. The Red Sea contains extensive areas of coral reefs, supporting high levels of diversity with numerous endemic species. Seagrass meadows and mangrove stands are also common. Despite the relatively low population density along most of the Red Sea shores, coastal development has intensified over the last few decades and is not expected to slow down. Marine communities face increasing pressures from fishing, shipping, oil exploration, aquaculture, desalination discharges, growing human population, terrestrial run-off, plastic waste, and climatic changes. Projections of increasing tourism add further pressures and, if sound marine spatial planning tools are not in place, could result in adverse effects for the sustainable management of resources. Current levels of contamination are overall low but coral reefs show signs of overfishing and there are also signs of homogenization of coral reef communities along the entire latitudinal gradient, probably due to anthropogenic pressures. Ecosystem-based management approaches are urgently needed for sustainable management.