Mean sea level rise (SLR) could increase up to 2m by 2100, which would see damage caused by coastal flooding in Europe increase from €1.25bn per annum currently to €961bn in just over 80 years. Urban areas situated along the North Sea coastline are particularly vulnerable to extreme sea level rise (a combination of SLR, tide, and storm surges). The main goal of this study is to assess the paradigm shift in flood risk management from reducing probability of the flood event to reducing its consequences in the city of Vlissingen, in the Netherlands. Two spatial adaptation strategies are modeled and compared by using spatial, climatic, and socioeconomic projections for the year 2100: the “Vlissings Model” and the “Spuikom Model.” The Vlissings Model is about increased coastal protection through the heightening of existing grey infrastructure by 3 m, which includes the dike and buildings constructed on top of it. The Spuikom Model is accepting and rerouting overtopping water towards an existing former backshore water basin. The study brings forth an interdisciplinary “Design & Assess” framework that brings together design strategies with flood damage models and cost/benefit analyses to compare the effectiveness of two paradigms in dealing with extreme SLR.