Knowledge-based urban development in metropolitan regions can help shape the social and physical renewal required to respond to current rapid change. Decision making can be devolved, participation promoted, regional networks of production and culture developed, coherent planning and servicing of settlements introduced to transcend local government boundaries, and resource consumption and pollution can be controlled at the metropolitan/regional scale. Examples of successful development of creative urban regions include metropolitan regions in Europe and North America based on one or more of the five paradigms of cultural self-renewal, inclusive creativity, economic vitality and communication, self-sustaining environmental quality, and the empowering effects of participatory governance. Their planning can draw on a wide range of well-established methods, ranging from long-established central place theory to ideas of wholeness developed by Alexander (2002). Well-established practices of advocacy, voluntarism, institutional innovation, and regular evaluation can be linked to build the regional consciousness and institutions required to implement these solutions for the regions to become creative urban regions.