The increased incidence of health disturbances and the decrease in fertility observed in modern dairy cows selected for high milk yield remains largely unimproved. The one-sided selection for high milk yields increased the gap between the output of nutrients with milk and the input via voluntary feed intake. It also exerts negative effects on immune competence, reproduction, and thus lifetime performance. The endeavor for adapting housing, feeding and management to the demands of such cows has not resulted in a noticeable reversal of the trend, nor has the additional consideration of functional “fitness” traits besides milk yield in breeding. Due to limitations in availability and quality of forage, feeding became highly dependent of imported protein-rich feed and also went into competition for crops suitable for human nutrition. Beside these problems, the use of antibiotics, fate of male calves, as well as the detrimental ecological and economic effects represent relevant issues in the public perception and also reduce the production efficiency of dairying. The present contribution will elucidate open potentials and their sustainability, but also restrictions of alternative production strategies under consideration of existing physiological limitations. Such strategies might include for instance improving the rearing practices for dairy calves, use of dual purpose breeds, shortening the dry-period length, extending lactation by delaying insemination, and individualized feeding. Feed additives may also have potential to alleviate deficiencies, at least in short-term. Breaking the peak of the lactation curve by either omitting the dry period or manipulating the endocrine regulation of early galactopoesis imply economic losses due to only partial use of the available genetic potential, but reduce the metabolic load, risk of health disorders and culling. Within each individual local production system efficiency must be maximized and intensification in pasture-based milk production systems with suitable genotypes may result in higher methane emission, but allow welfare orientated animal husbandry and efficient use of nitrogen and grassland sources without competition for human food and costly concentrate supplementation.