Seawater membrane distillation (SWMD) is a promising separation technology due to its ability to operate as a stand-alone desalination unit operation. This paper reviews approaches to improve laboratory-to-pilot-scale MD performance, which comprise operational strategies, module design, and specifically tailored membranes. A detailed comparison of SWMD and sea water reverse osmosis is presented to further analyze the critical shortcomings of SWMD. The unique features of SWMD, namely the ability to operate with extremely high salt rejection and at extreme feed concentration, highlight the SWMD potential to be operated under zero liquid discharge (ZLD) conditions, which results in the production of high-purity water and simultaneous salt recovery, as well as the elimination of the brine disposal cost. However, technical challenges, such as thermal energy requirements, inefficient heat transfer and integration, low water recovery factors, and lack of studies on real-case valuable-salt recovery, are impeding the commercialization of ZLD SWMD. This review highlights the possibility of applying selected strategies to push forward ZLD SWMD commercialization. Suggestions are projected to include intermittent removal of valuable salts, in-depth study on the robustness of novel membranes, module and configuration, utilization of a low-cost heat exchanger, and capital cost reduction in a renewable-energy-integrated SWMD plant.