Elkhorn coral (Acropora palmata) populations provide important ecological functions on shallow Caribbean reefs, many of which were lost when a disease reduced their abundance by more than 95% beginning in the mid-1970s. Since then, a lack of significant recovery has prompted rehabilitation initiatives throughout the Caribbean. Here, we report the first successful outplanting and long-term survival of A. palmatasettlers reared from gametes collected in the field. A. palmata larvae were settled on clay substrates (substrate units) and either outplanted on the reef two weeks after settlement or kept in a land-based nursery. After 2.5 years, the survival rate of A. palmata settlers outplanted two weeks after settlement was 6.8 times higher (3.4%) than that of settlers kept in a land-based nursery (0.5%). Furthermore, 32% of the substrate units on the reef still harbored one or more well-developed recruit compared to 3% for substrate units kept in the nursery. In addition to increasing survival, outplanting A. palmata settlers shortly after settlement reduced the costs to produce at least one 2.5-year-old A. palmataindividual from $325 to $13 USD. Thus, this study not only highlights the first successful long-term rearing of this critically endangered coral species, but also shows that early outplanting of sexually reared coral settlers can be more cost-effective than the traditional approach of nursery rearing for restoration efforts aimed at rehabilitating coral populations.