What is wrong with the peer review system? Is peer review sustainable? Useful? What other models exist? These are central yet contentious questions in today’s academic discourse. This perspective critically discusses alternative models and revisions to the peer review system. The authors highlight possible changes to the peer review system, with the goal of fostering further dialog among the main stakeholders, including producers and consumers of scientific research. Neither our list of identified issues with the peer review system nor our discussed resolutions are complete. A point of agreement is that fair assessment and efficient change would require more comprehensive and rigorous data on the various aspects of the peer review system.