The Mediterranean Sea has been the cradle of Western civilization and its coastal communities have been exploiting all forms of marine life, since ancient times. Concerns regarding fishing and the effects of overfishing were hypothesized as far back as the 14th century. More significant in terms of employment than production, Mediterranean fisheries are characterized by high diversity of catches, relatively small size of specimens and numerous small scale vessels. About 85 percent of Mediterranean stocks, currently assessed, are fished at biologically unsustainable levels with exploitation rate steadily increasing, selectivity deteriorating, and stocks shrinking. The most encouraging message is that the state of knowledge on the fish stocks has improved rapidly and the number of assessed stocks has almost doubled recently. Due to the multinational status of the Mediterranean waters, a maze of management regulations is currently in place, varying among neighbouring countries. Given the special characteristics and 'peculiarities' of the Mediterranean Sea, an effort-regulating regime has been considered as the most appropriate management strategy, accompanied by licensing schemes, closed areas and technical measures. The effectiveness of this management approach is reflected on the alarming state of the stocks. Furthermore, Mediterranean fisheries have a notorious reputation as having an inherent 'culture of non-compliance' largely ignoring rules. Current levels of control and enforcement are insufficient to confront fleets with a large number of vessels and recent economic crisis has amplified the problem. It seems that the impacts of Mediterranean fisheries on fish stocks and marine ecosystems need to be reassessed based on new approaches, either shifting towards simple catch-based management or the more elaborate ecosystem based management. However, the ultimate goal should be to change the mind-set of fishers and motivate them to produce the right type of seafood without exposing themselves to bad practices and exposing the ecosystem to unsustainable exploitation.