Regional sea level changes can deviate substantially from those of the global mean, can vary on a broad range of timescales, and in some regions can even lead to a reversal of long-term global mean sea level trends. The underlying causes are associated with dynamic variations in the ocean circulation as part of climate modes of variability and with an isostatic adjustment of Earth's crust to past and ongoing changes in polar ice masses and continental water storage. Relative to the coastline, sea level is also affected by processes such as earthquakes and anthropogenically induced subsidence. Present-day regional sea level changes appear to be caused primarily by natural climate variability. However, the imprint of anthropogenic effects on regional sea level—whether due to changes in the atmospheric forcing or to mass variations in the system—will grow with time as climate change progresses, and toward the end of the twenty-first century, regional sea level patterns will be a superposition of climate variability modes and natural and anthropogenically induced static sea level patterns. Attribution and predictions of ongoing and future sea level changes require an expanded and sustained climate observing system.