The current design practice for the vertical profile of roads in rolling and mountainous terrains is to follow the existing grades in order to minimize earthwork costs. This means that the only criterion considered during the design phase is the initial cost. It would be preferable to include other criteria that are directly related to sustainability, particularly fuel consumption and CO₂ emissions. Therefore, this paper describes a proposed design procedure that starts by finding feasible alternatives with different grades. Then, a microsimulation traffic tool is used to simulate the movement of predicted vehicles (volume and type) over the different alternatives. The microsimulation tool provides reliable estimates of travel times, fuel consumption, and CO₂ emissions for the different alternatives. With these data, it is possible to use life cycle cost analysis (LCCA) or multiple criteria decision aid (MCDA) tools to select the “optimal” alternative. The proposed procedure was used on a case study involving a 6-km highway section with different proposed grades ranging from 2% to 8%. Using LCCA and an MCDA tool, it was revealed that the current design alternative is not the optimal alternative in most considered scenarios (various fuel values for LCCA and different “Cost” weights for MCDA).