The wind energy industry relies heavily on computational fluid dynamics (CFD) to analyze new turbine designs. To utilize CFD earlier in the design process, where lower-fidelity methods such as blade element momentum (BEM) are more common, requires the development of new tools. Tools that utilize numerical optimization are particularly valuable because they reduce the reliance on design by trial and error. We present the first comprehensive 3-D CFD adjoint-based shape optimization of a modern 10 MW offshore wind turbine. The optimization problem is aligned with a case study from International Energy Agency (IEA) Wind Task 37, making it possible to compare our findings with the BEM results from this case study and therefore allowing us to determine the value of design optimization based on high-fidelity models. The comparison shows that the overall design trends suggested by the two models do agree, and that it is particularly valuable to consult the high-fidelity model in areas such as root and tip where BEM is inaccurate. In addition, we compare two different CFD solvers to quantify the effect of modeling compressibility and to estimate the accuracy of the chosen grid resolution and order of convergence of the solver. Meshes up to 14 × 106 cells are used in the optimization whereby flow details are resolved. The present work shows that it is now possible to successfully optimize modern wind turbines aerodynamically under normal operating conditions using Reynolds-averaged Navier–Stokes (RANS) models. The key benefit of a 3-D RANS approach is that it is possible to optimize the blade planform and cross-sectional shape simultaneously, thus tailoring the shape to the actual 3-D flow over the rotor. This work does not address evaluation of extreme loads used for structural sizing, where BEM-based methods have proven very accurate, and therefore will likely remain the method of choice.