This paper examines the experience with regional cumulative effects assessment (CEA) in the Great Sand Hills, Saskatchewan, Canada, and the lessons that emerge for better practice. The benefits of a regional approach to CEA are widely discusssed; however, in practice, regional CEA, particularly in Canada, has fallen short of its potential. Part of the reason for this, arguably, is the lack of strategic frameworks to support good practice. Most attempts at regional CEA have been constrained by the strong influence of project-based environmental assessment, and are focused on modeling past and present stressors and responses, rather than on projecting cumulative trends and systematically identifying and evaluating desirable futures. Regional CEA is inherently futures-oriented. This requires a supporting SEA framework, structured scenario-based analysis, a multi-scaled perspective, and an integrated approach to CEA and regional plan development.