The current climate change crisis poses significant risks and challenges to the protection and preservation of cultural heritage sites. This is particularly true in the Pacific with its many small, low-lying, and remote islands that have been inhabited by humans for millennia in ways that were demonstrably sustainable and resilient. To examine the potential effects of impending sea level rise and other issues, we conducted the first phase of a targeted survey of significant cultural heritage sites in Palau with the primary goal of assessing climate change-related threats to these resources and providing recommendations for mitigating the impacts. Ten sites across the entire length of Palau’s national boundaries were chosen for their recognized cultural and historical value and their perceived susceptibility to sea level rise, erosion, and other natural processes. Our survey results demonstrate that all 10 sites are currently under threat, especially from sea level rise which is already causing extensive damage and will inundate and/or potentially destroy most of them in the very near future. Given that hundreds of culturally and historically significant sites are found in low-lying coastal areas throughout the Palauan archipelago, representing centuries of human-environmental interaction, there is a critical and urgent need to document, preserve, and/or protect these sites in the near future before they are lost forever. As Palau and many other island nations grapple with climate change, what can be done to mitigate these effects and how can traditional practices embedded within deep time cultural traditions be used to help both interpret these sites and provide pathways toward long-term sustainability?