Innovation and creativity are seen as important drivers of urban or regional economic growth. Yet, there is now increasing concern about the consequences of innovation in a city or region. The chapter considers these issues and the potential impact of innovation on inequality. It first considers the link between innovation, creativity and inequality within cities and regions and the evidence on the extent to which the benefits of innovation-led growth are evenly shared. Next, it considers the current academic and policy agendas around creativity and the challenges faced in cities pursuing strategies based on creativity. It argues that while the consequences of innovation may be difficult, the consequences of too little innovation may be worse: this is a classic case of the dilemma between equity versus efficiency.