The rise in global demand for seafood has led many people to view shellfish aquaculture as an economically and ecologically viable source of seafood. However, interactions with the environment, existing industry, and societal values must be considered to ensure sustainability of this industry. Shellfish aquaculture in British Columbia (BC), Canada, showcases many of these issues. This review explores key socio-economic and ecological considerations for future growth of shellfish aquaculture on the central and north coast of BC, with implications for the continuing global expansion of the industry. Interactions among shellfish aquaculture, coastal groups, existing industries, and First Nations, as well as considerations under changing oceanic conditions are investigated. Expansion of shellfish aquaculture on the central and north coast of BC will need to be socially, environmentally, and economically sustainable. The results of this review strongly indicate that shellfish aquaculture should be incorporated in marine planning initiatives and developed in consideration of local ecological, environmental, economic, and social context.