Methods of predicting mineral scale formation have evolved over the years from simple empirical fittings to sophisticated computational programs. Though best practices can now solve complex multi-phase, multi-component systems, they are largely restricted to temperatures below 300 °C. This review examines critical gaps in existing mineral scale modeling approaches as well as strategies to overcome them. Above 300 °C, the most widely used model of standard thermodynamic functions for aqueous species fails when fluid densities are below 0.7 g cm−3. This failure occurs due to the model’s reliance on an empirical form of the Born equation which is unable to capture the trends observed in these high temperature, low density regimes. However, new models based on molecular solvent-solute interactions offer a pathway to overcome some of the deficiencies currently limiting high-temperature and high-pressure mineral scale predictions. Examples of the most common scale prediction methods are presented, and their advantages and disadvantages are discussed.