In looking toward the future of chronic thromboembolic pulmonary hypertension, the following four clinical questions deserve careful consideration: (1) What is inoperable disease, and how is it defined? (2) Is there a role for targeted medical therapy in technically operable, proximal disease? (3) Where does balloon pulmonary angioplasty fit into the treatment algorithm? (4) How should we approach patients with symptomatic chronic pulmonary thromboembolism without pulmonary hypertension? The search for these answers will continue to propel this field forward. Consequently, the crossroads we find ourselves at signal opportunity and hope for future advances.