Increasing awareness of the need to reduce greenhouse gas emissions has renewed interest in nuclear power generation. At the same time, the longstanding logjam over how to manage spent nuclear fuel continues to hamper the expansion of nuclear power. If nuclear power is to be a sustainable option for the United States, methods for managing spent fuel that meet stringent safety and environmental standards must be implemented. This monograph evaluates the main technical and institutional approaches to spent nuclear fuel management and identifies implications for the development of spent fuel management policy. The authors find that on-site storage, centralized interim storage, and permanent geological disposal are generally safe, secure, and low- to moderate-cost approaches with no insurmountable technical obstacles. Advanced fuel cycles enabling spent-fuel recycling could reduce waste repository capacity needs but are difficult to evaluate because they still in early research stages. Public acceptance challenges stand as a major impediment to any technical approach. The analysis shows that the technical approaches can be combined in different ways to form different spent fuel management strategies that can be distinguished primarily in terms of societal preferences in three areas: the disposition of spent fuel, the growth of nuclear power, and intergenerational trade-offs.