Sandra Featherman believes that colleges are in denial about the severity of the threats to the current model of higher education. Based on her own experience as a president, as a trustee, and as a board member who has worked in private and public universities - and on interviews with the presidents of major institutions - she offers both a trenchant analysis of those threats and clear prescriptions about the painful but necessary decisions that colleges need to make to ensure they remain viable, accessible and affordable, and deliver a high-quality education. Sandra Featherman considers higher education to be at a game-changing moment. When markets don't function well - as is the case with today's college marketplace with offerings that cost too much and return too little - it opens the door to new types of suppliers, who offer new ways of providing what students are looking for, particularly the increasing cohort of mature, working students. In the face of new competitors - for-profit education companies, technology start-ups, and foreign universities vying for international students - trustees and senior level administrators are generally stuck in a traditional ethos and with decision-making processes unsuited to these times. They know what used to work, and find it easier to follow old ways than to make the difficult transition to new ways of delivering education. She lays out a strategy: that emphasizes the centrality of students and how to provide them with the most effective learning environment; that is clear-eyed about focusing on the core missions, and abandoning practices that constrain or impede them; and that requires constant self-monitoring to learn from and act upon what works. She offers a blueprint for redesigning institutions, for paring away what is unnecessary and cost ineffective, and for adopting the best technologies, all in the service of developing meaningful degree programs at an affordable price, and widening access for under-represented groups. She ranges over the implications of budget decisions, accreditation, and MOOCs; addresses government regulation and tuition costs; presents promising new models; and concludes with 11 key recommendations that should be heeded by all higher education administrators and trustees.