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Increasing regulatory pressures to reduce shipping emissions have led to the design of low-emission vessels. These may rely on more sustainable propulsion and/or resistance reduction to reduce fuel consumption. However, the structural implications of such design strategies remain to be fully ascertained. This paper presents a review of the recent literature to identify the structural challenges associated with the next generation of sustainable vessels and tackles a range of available design options intended to reduce emissions. The results suggest that structural design has a fundamental role to play in enabling the application of low-emission design strategies on both small crafts and ships, but further developments in rules and regulations are necessary. It is anticipated these findings may support future regulatory advancements and may contribute to improvements in the design of sustainable vessels.