This research explores the development of sustainable tourism in destinations in the Baltic region and in the case of Visby, Gotland. The purpose is to contribute to the understanding how destination management organisations and local communities in these destinations work together to develop the destination. The aim is to investigate how these actors work together in practice and to compare the findings with an ideal collaborative approach. The research design consists of a mixed-method approach and uses two web-based questionnaires to investigate the destinations in the Baltic region and in-depth interviews to gain insights into the case of Visby, Gotland. The research findings provide information on how sustainable tourism is targeted and understood in the destinations and what drivers and barriers for a collaborative approach exist. The findings create a better understanding on how different actors in the destination work and why an ideal collaborative approach is a necessity for the development of a sustainable destination. Overall, the results shed light on the fact that an ideal collaboration can overcome the four major lacks (lack of communication, lack of knowledge, lack of responsibilities, and lack of support) as found in the destinations. This study provides an understanding of factors affecting the development of a collaborative approach and thereby, the development of sustainable tourism. Further, the study highlights how an ideal collaborative approach in a destination can foster sustainability in the tourism industry.