Following the near death experience of the federal gift and estate tax in 2010, the hundredth anniversary of the tax represents an ideal moment to reflect on the role of this tax and whether an alternative approach might be more desirable and sustainable. This Article examines four prominent alternatives to the current tax: an annual wealth tax, taxing unrealized gains at death, including gifts and inheritances in income, and a lifetime accessions tax that would apply to the cumulative value of gifts and inheritances received by individuals over their lifetimes. In order to assess these alternatives, the Article reconsiders the reasons for taxing wealth transfers, arguing that the primary purpose of a wealth transfer tax is not to raise revenue or enhance progressivity, but to regulate intergenerational transfers of wealth in order to reduce unearned concentrations of wealth and power and promote fair equality of opportunity. On this basis, it argues that a lifetime accessions tax is an attractive alternative to the current tax.