‘Ocean Cities’ of the Pacific are where urban landscapes and seascapes meet, where built and natural environments interface, and where human behaviour and urban development have profound impacts on both terrestrial and marine ecosystems. Ocean Cities are at the forefront of climate change consequences, urbanisation challenges, and other development pressures. This article discusses the potential for nature-based solutions (NbS), including those focused on ecosystem services, in Pacific Small Island Developing States (SIDS) as a response to climate change, population growth, and urbanisation. Attention is directed to identifying the benefits of NbS and case-studies from Pacific SIDS, and if not available regionally, further afield. The article provides focus on possible barriers to implementation of NbS in a Pacific SIDS context and potential policy responses to these. Conclusions are threefold: (i) addressing interlinked ecological, climate, and human wellbeing issues in an integrated, ocean-focused and climate-responsive manner is vital for sustainable development in island systems; (ii) NbS can provide significant human wellbeing and biodiversity benefits in this context; and (iii) Pacific Ocean Cities, with a significant body of relevant traditional knowledge and emerging NbS experience, can inform global understanding of how to address converging urbanisation and climate change issues in Ocean Cities.