Prescribed fire is an important management tool for restoring fire-adapted ecosystems and mitigating the risk of high-severity wildfire in the North American Mediterranean climate zone (NAMCZ), much of which was historically characterized by frequent low- to moderate-severity fire. For over a century, policies that excluded fire, curtailed Indigenous cultural burning, and prioritized timber harvesting have, in combination with anthropogenic climate warming, driven large-scale, high-severity fires that are wreaking ecological and socioeconomic havoc. Despite its recognized need, the use of prescribed fire at appropriate scale has been slow to occur. We describe some of the principal obstacles to increasing the application of prescribed fire in the NAMCZ and suggest four strategies for policy makers and high-level managers to overcome them: (1) redoubling federal and state agency commitment and rewarding assertive leadership, (2) increasing funding for prevention-focused management (as opposed to suppression), (3) building capacity through cooperation, and (4) expanding monitoring to inform burn strategies and adaptive management.