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There is an unstoppable willingness to measure the world, everything everywhere, that is making the IoT adoption relentless. However, a key enabler is connectivity, which is only present in about 15% of the world's surface. Demand for IoT connectivity services, also referred to as MTC , is growing in the general consumer market as well as across multiple and diverse vertical sectors such as transportation and logistics, agriculture, fishing and maritime, Oil and Gas ( O&G ), wildlife, critical infrastructures, utilities, environmental, outdoor sports, livestock, and others. Within these sectors, a significant number of IoT applications are anticipated to rely on or strongly benefit from satellite-based IoT connectivity solutions able to reach isolated or remote locations outside the footprint of terrestrial networks (e.g. precision live stock farming in rural areas) and provide global coverage on Earth (e.g. asset tracking and monitoring in international logistics). In particular, IoT connectivity solutions built upon a common communication technology for both terrestrial and satellite access, alongside a reduced price for satellite connectivity, stand as an unprecedented opportunity to achieve true cost-efficient and ubiquitous coverage and, ultimately, foster the massive adoption of IoT services. In this context, this chapter first provides an overview of the current satellite IoT market along with the prospects for satellite mMTC services. Next, a discussion on potential business models, ecosystems, and approaches seeking to turn into reality such a massive IoT / mMTC market via satellite access is presented. Finally, the chapter also elaborates on system design aspects and principles to consider when pursuing the technical realization of cost-efficient satellite mMTC service delivery (e.g. solutions based on nanosatellites, sparse constellations, and store and forward operation) and concludes with an illustrative assessment of capacity and key performance indicators at the service level for a potential satellite IoT system realization.