Back in 2002, Sustainable Pittsburgh completed a Sustainability Assessment of the Northern Sections of the Mon Fayette Expressway (MFE). Independent expert review, public testimony, and days spent with the PA Turnpike Commission’s (PTC’s) consulting team to gain precise insights made for an exhaustive process. At the time, PTC agreed with Sustainable Pittsburgh’s key findings that truly comprehensive analyses were not thoroughly conducted of transportation alternatives nor economic impacts. PTC is once again advancing the plan to extend the MFE from Jefferson Hills through the city of Duquesne to Monroeville. Certainly the times have changed. More than ever, no one size road fits all community needs. As stated in the 2002 sustainability assessment, the PTC has only one mission under Pennsylvania law — to build and administer toll roads. PTC is not an advocate, but rather a facilitator of the MFE, having been tasked to build the toll road at the will of the PA legislature harkening back a vision initiated in the 1950s. The simple fact that the PTC’s legislative charter does not include options other than toll road construction may be a constraint. Just the same, given its $2.16 billion estimated cost, advancement of this northern leg of the MFE should be closely scrutinized for substantiation of how the investment will economically (including public health) impact the communities it was envisioned to help. Furthermore, contemporary approaches to multimodal transportation alternatives should be thoroughly examined and debated in the context of mobility and emissions reduction priorities for sustainable communities and of the changing region — one that remains in nonattainment with standards of the Clean Air Act.