In the United States, the aquaculture industry has not seen the same levels of growth in production as other countries—made evident by the $17 billion seafood trade deficit estimated in 2020. Nevertheless, aquaculture remains an important industry fully capable of supplementing the domestic seafood supply and reducing the US seafood trade deficit. Infectious diseases is one of several factors that threatens the capability and sustainability of the aquaculture industry, highlighting the importance of effective control strategies for these pathogens. Antimicrobial products are often used to control and eliminate undesirable microbes in effort to prevent or mitigate the impacts of infectious diseases. Some pathogens are capable of adapting to and resisting the antimicrobial effects, escalating the challenges associated with disease management in aquaculture. Antimicrobial resistance (AMR) is now recognised by numerous national and international agencies as a top global health concern and is problematic for US aquaculture. Currently, disease prevention and mitigation strategies utilised by US finfish aquaculture can be broken down into three levels; comprehensive protocols (biosecurity, disease response), good husbandry strategies (stress management, proper diet, optimal environment) and effective antimicrobial products (biocides, therapeutics). This review will discuss how each level contributes differently to the overall protection of fish from pathogens. In the era of AMR, this review will also highlight current and emerging alternative strategies that do not rely on traditional antimicrobial products (e.g., vaccines, dietary supplements, novel antimicrobial, stock selection) for disease prevention and mitigation.