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Atolls islands are biogenic landforms that are intrinsically capable of adjusting their size, position, and elevation to changing sea levels. The vulnerability of atoll islands to sea level rise is not intrinsically due to their low elevation but primarily due to the loss of their island building capacity. The geophysical processes that control atoll island accretion are being impacted on global and local scales. Protecting and restoring the natural geophysical processes of atoll island accretion through local conservation actions is key to unlocking nature-based opportunities for enhancing atoll resilience to global change. Atoll islands are often perceived as inevitably lost due to rising sea levels. However, unlike other islands, atoll islands are dynamic landforms that have evolved, at least historically, to vertically accrete at a pace commensurate with changing sea levels. Rather than atoll islands' low elevation per se , the impairment of natural accretion processes is jeopardising their persistence. While global marine impacts are deteriorating coral reefs, local impacts also significantly affect accretion, together potentially tipping the scales toward atoll island erosion. Maintaining atoll island accretion requires intact sediment generation on coral reefs, unobstructed sediment transport from reef to island, and available vegetated deposition sites on the island. Ensuring the persistence of atoll islands must include global greenhouse gas emission reduction and local restoration of accretion processes. [ABSTRACT FROM AUTHOR]