Coastal wetlands provide a wide array of ecosystem services, valued at trillions of dollars per year globally. Although accelerating sea level rise (SLR) poses the long-term threat of inundation to coastal areas, wetlands may be sustained in two ways: by positive net surface-elevation change (SEC) from sediment and organic matter buildup and by accommodation, or horizontal migration into refugia—low-lying, undeveloped upland areas that become inundated. Using a simple model together with high-resolution elevation data, we provide, across the contiguous United States, analysis of the local effects of SLR, maximum SEC rates, and coastal development on the long-term resilience of coastal wetlands. We find that protecting current refugia is a critical factor for retaining wetlands under accelerating SLR. If refugia are conserved under an optimistic scenario (a high universal maximum SEC rate of 8mm/yr and low greenhouse gas emissions), wetlands may increase by 25.0% (29.4%−21.5%; 50th, 5th−95th percentiles of SLR) by the end of the century. However, if refugia are developed under a more pessimistic scenario (a low universal maximum SEC rate of 3mm/yr, high greenhouse gas emissions, and projections incorporating high ice-sheet contributions to SLR), wetlands may decrease by -97.0% (-82.3%−-99.9%). These median changes in wetland area could result in an annual gain of ∼$222 billion compared to an annual loss of ∼$732 billion in ecosystem services in the US alone. Focusing on key management options for sustaining wetlands, we highlight areas at risk of losing wetlands and identify the benefits possible from conserving refugia or managing SEC rates.