Rodents are a key pest to agricultural and rural island communities of the South Pacific, but there is limited information of their impact on the crops and livelihoods of small-scale farmers. The rodent pest community is known, but the type and scales of damage to different crops on different islands are unknown. Knowledge about rodent pest management in other geographical regions may not be directly transferable to the Pacific region. Many studies on islands have largely focussed on the eradication of rodents from uninhabited islands for conservation benefits. These broadscale eradication efforts are unlikely to translate to inhabited islands because of complex social and agricultural issues. The livelihoods, culture and customs of poor small-scale farmers in the South Pacific have a large bearing on the current management of rodents. The aim of the present review was to describe the rodent problems, impacts and management of rodents on South Pacific islands, and identify gaps for further research. We compared and contrasted two case studies. The situation in Papua New Guinea is emergent as several introduced rodent species are actively invading new areas with wide-ranging implications for human livelihoods and conservation. In Vanuatu, we show how rodent damage on cocoa plantations can be reduced by good orchard hygiene through pruning and weeding, which also has benefits for the management of black pod disease. We conclude that (1) damage levels are unknown and unreported, (2) the impacts on human health are unknown, (3) the relationships between the pest species and their food sources, breeding and movements are not known, and (4) the situation in Papua New Guinea may represent an emergent crisis that warrants further investigation. In addition, there is a need for greater understanding of the invasive history of pest rodents, so as to integrate biological information with management strategies. Ecologically based rodent management can be achieved on Pacific Islands, but only after significant well funded large-scale projects are established and rodent ecologists are trained. We can learn from experiences from other locations such as Southeast Asia to guide the way.