This report provides the most comprehensive body of research yet assembled on growth and development patterns in a bellwether Midwestern state. Overall, the report documents that Missouri's population is spreading out to an extreme degree that imposes substantial fiscal, economic, environmental, and social costs on communities and taxpayers. Capping the report is a fiscally prudent set of recommendations intended to help the state give communities the tools, incentives, and opportunities to grow in more efficient and fiscally responsible ways.