Since 1999, the black rat (Rattus rattus) has been eradicated from 14 Italian islands, and eradication is ongoing on a further five islands. Most projects were funded by the European Union (EU) Life Programme. Over the years, eradication techniques have been improved and adapted to different situations, including aerial bait distribution on islands with large inaccessible areas, which otherwise would have relied on a manual bait distribution. A priority list of eradications on islands, which was compiled ten years ago, has been met to a large extent, as rats have been successfully eradicated from many islands of great importance to breeding seabirds. Despite some cases of re-invasion occurring in early projects, advances in biosecurity measures have allowed for eradications on islands where this was previously considered unfeasible due to a high risk of re-invasion. This paper reports on black rat eradication work performed on Italian Mediterranean islands with small villages. We show biodiversity benefits of these programmes, but also qualitatively address socio-economic and health impacts on local communities. Eradication projects have faced new obstacles, due to recent changes in legislation which complicated the application of rodenticides and made it very difficult to get permission for aerial distribution of bait on some of the priority islands.