Meeting the new challenges of gamma-ray astronomy will be difficult. The variety of sources and the nature of their emissions over a wide range of energy and intensities will undoubtedly require an integrated observatory, or its equivalent, in the fashion of Compton. However, for the study of sources in the MeV range, a new Compton telescope will be necessary. It must possess an effective area much greater than COMPTEL, but also reject background more efficiently than COMPTEL. With these properties, one could easily attain an order of magnitude improvement in sensitivity over COMPTEL, opening up numerous investigations while providing a rich catalog of sources for subsequent study. Future goals not only include conducting observations over the wide energy range from 0.3 to 20 MeV, but also performing the best possible measurements of narrow and broad lines, point sources and extended objects, and steady state and transient sources with a large dynamic range. We review the demands on and the challenges in developing a medium energy Compton gamma-ray telescope that can make significant strides in our understanding of the Universe.