Smallholder-targeted value chain development is one of the most important market-based strategies for rural development. A wealth of research shows smallholder-targeted value chains can potentially deliver considerable benefits for participating smallholders. However, a divergence in experiences suggests trade-offs: between value outcomes delivered for rural communities; between delivering value and engaging with target populations; and between target development outcomes and the incentives of commercial agribusiness. In this paper we seek to describe how the domains of inclusion, value, and scaling-out should be considered for smallholder-targeted value chains development, and to what extent trade-offs between these domains emerge for smallholder-targeted value chains. To answer these questions, we present a scoping literature review of outcome identification and measurement in smallholder-targeted value chains case studies. From a sample of 344 case studies we show strong evidence for trade-offs. Specifically, smallholder-targeted value chains delivering high-value farm performance outcomes are 87% less likely to be inclusive, relative to value chains with low farm performance outcomes. From the findings of the scoping review, we map the pathways and drivers for the mutual achievement of value, inclusivity, and scalability outcomes for smallholder-targeted value chains. Our review is critical but positive – it presents a critical need for updates to value chain design, but provides the starting point for this design work to be nested within clear conceptual foundations and standardised measures of value chain ‘success’ for rural development.