The perspectives of future development of geothermal power plants, mainly of small size for the exploitation of medium-low temperature reservoirs, are discussed and analyzed in the present paper. Even if there is a general interest in new power plants and investments in this sector are recognized, the new installations are reduced; the apparent advantage of null cost of the energy source is negatively balanced by the high drilling and installation costs. A key element for the design of a geothermal plant for medium temperature geothermal source is the definition of the power of the plant (size): this is important in order to define not only the economic plan but also the durability of the reservoir. Considering that it is not possible that the development of geothermal industry could be driven only by an economic perspective, the authors propose a method for joining energetic and economic approaches. The result of the combined energetic and economic analysis is interesting particularly in case of Organic Rankine Cycle (ORC) power plants in order to define a suitable and optimal size and to maximize the resource durability. The method is illustrated with reference to some particular case studies, showing that the sustainability of small size geothermal plants will be approached only if the research for more economic solutions will be combined with efforts in direction of efficiency increase. (C) 2014 Elsevier Ltd. All rights reserved.