Southern highbush blueberry cultivation has expanded into non-traditional growing areas worldwide due to elite cultivars and improved horticultural practices. This article presents a comprehensive review of current production systems—alternatives to traditional open field production—such as production in protected environments, high-density plantings, evergreen production, and container-based production. We discuss the advantages and disadvantages of each system and compare their differences to open field production. In addition, we provide potential solutions for some of the disadvantages. We also highlight some of the gaps existing between academic studies and production in industry, providing a guide for future academic research. All these alternative systems have shown the potential to produce high yields with high-quality berries. Alternative systems, compared to field production, require higher establishment investments and thus create an entry barrier for new producers. Nevertheless, with their advantages, alternative productions have the potential to be profitable.