diff --git a/datasette/default_permissions.py b/datasette/default_permissions.py
index d29dbe84..c13f2ed2 100644
--- a/datasette/default_permissions.py
+++ b/datasette/default_permissions.py
@@ -8,7 +8,6 @@ from typing import Union, Tuple
 @hookimpl
 def register_permissions():
     return (
-        # name, abbr, description, takes_database, takes_resource, default
         Permission(
             name="view-instance",
             abbr="vi",
@@ -109,6 +108,14 @@ def register_permissions():
             takes_resource=False,
             default=False,
         ),
+        Permission(
+            name="alter-table",
+            abbr="at",
+            description="Alter tables",
+            takes_database=True,
+            takes_resource=True,
+            default=False,
+        ),
         Permission(
             name="drop-table",
             abbr="dt",
@@ -129,6 +136,7 @@ def permission_allowed_default(datasette, actor, action, resource):
             "debug-menu",
             "insert-row",
             "create-table",
+            "alter-table",
             "drop-table",
             "delete-row",
             "update-row",
diff --git a/datasette/events.py b/datasette/events.py
index 96244779..ae90972d 100644
--- a/datasette/events.py
+++ b/datasette/events.py
@@ -108,6 +108,30 @@ class DropTableEvent(Event):
     table: str
 
 
+@dataclass
+class AlterTableEvent(Event):
+    """
+    Event name: ``alter-table``
+
+    A table has been altered.
+
+    :ivar database: The name of the database where the table was altered
+    :type database: str
+    :ivar table: The name of the table that was altered
+    :type table: str
+    :ivar before_schema: The table's SQL schema before the alteration
+    :type before_schema: str
+    :ivar after_schema: The table's SQL schema after the alteration
+    :type after_schema: str
+    """
+
+    name = "alter-table"
+    database: str
+    table: str
+    before_schema: str
+    after_schema: str
+
+
 @dataclass
 class InsertRowsEvent(Event):
     """
@@ -203,6 +227,7 @@ def register_events():
         LogoutEvent,
         CreateTableEvent,
         CreateTokenEvent,
+        AlterTableEvent,
         DropTableEvent,
         InsertRowsEvent,
         UpsertRowsEvent,
diff --git a/datasette/views/database.py b/datasette/views/database.py
index 6d17b16c..bd55064f 100644
--- a/datasette/views/database.py
+++ b/datasette/views/database.py
@@ -10,7 +10,7 @@ import re
 import sqlite_utils
 import textwrap
 
-from datasette.events import CreateTableEvent
+from datasette.events import AlterTableEvent, CreateTableEvent
 from datasette.database import QueryInterrupted
 from datasette.utils import (
     add_cors_headers,
@@ -792,7 +792,17 @@ class MagicParameters(dict):
 class TableCreateView(BaseView):
     name = "table-create"
 
-    _valid_keys = {"table", "rows", "row", "columns", "pk", "pks", "ignore", "replace"}
+    _valid_keys = {
+        "table",
+        "rows",
+        "row",
+        "columns",
+        "pk",
+        "pks",
+        "ignore",
+        "replace",
+        "alter",
+    }
     _supported_column_types = {
         "text",
         "integer",
@@ -876,6 +886,20 @@ class TableCreateView(BaseView):
             ):
                 return _error(["Permission denied - need insert-row"], 403)
 
+        alter = False
+        if rows or row:
+            if not table_exists:
+                # if table is being created for the first time, alter=True
+                alter = True
+            else:
+                # alter=True only if they request it AND they have permission
+                if data.get("alter"):
+                    if not await self.ds.permission_allowed(
+                        request.actor, "alter-table", resource=database_name
+                    ):
+                        return _error(["Permission denied - need alter-table"], 403)
+                    alter = True
+
         if columns:
             if rows or row:
                 return _error(["Cannot specify columns with rows or row"])
@@ -939,10 +963,18 @@ class TableCreateView(BaseView):
                 return _error(["pk cannot be changed for existing table"])
             pks = actual_pks
 
+        initial_schema = None
+        if table_exists:
+            initial_schema = await db.execute_fn(
+                lambda conn: sqlite_utils.Database(conn)[table_name].schema
+            )
+
         def create_table(conn):
             table = sqlite_utils.Database(conn)[table_name]
             if rows:
-                table.insert_all(rows, pk=pks or pk, ignore=ignore, replace=replace)
+                table.insert_all(
+                    rows, pk=pks or pk, ignore=ignore, replace=replace, alter=alter
+                )
             else:
                 table.create(
                     {c["name"]: c["type"] for c in columns},
@@ -954,6 +986,18 @@ class TableCreateView(BaseView):
             schema = await db.execute_write_fn(create_table)
         except Exception as e:
             return _error([str(e)])
+
+        if initial_schema is not None and initial_schema != schema:
+            await self.ds.track_event(
+                AlterTableEvent(
+                    request.actor,
+                    database=database_name,
+                    table=table_name,
+                    before_schema=initial_schema,
+                    after_schema=schema,
+                )
+            )
+
         table_url = self.ds.absolute_url(
             request, self.ds.urls.table(db.name, table_name)
         )
@@ -970,11 +1014,14 @@ class TableCreateView(BaseView):
         }
         if rows:
             details["row_count"] = len(rows)
-        await self.ds.track_event(
-            CreateTableEvent(
-                request.actor, database=db.name, table=table_name, schema=schema
+
+        if not table_exists:
+            # Only log creation if we created a table
+            await self.ds.track_event(
+                CreateTableEvent(
+                    request.actor, database=db.name, table=table_name, schema=schema
+                )
             )
-        )
         return Response.json(details, status=201)
 
 
diff --git a/docs/authentication.rst b/docs/authentication.rst
index 8758765d..87ee6385 100644
--- a/docs/authentication.rst
+++ b/docs/authentication.rst
@@ -1217,6 +1217,18 @@ Actor is allowed to create a database table.
 
 Default *deny*.
 
+.. _permissions_alter_table:
+
+alter-table
+-----------
+
+Actor is allowed to alter a database table.
+
+``resource`` - tuple: (string, string)
+    The name of the database, then the name of the table
+
+Default *deny*.
+
 .. _permissions_drop_table:
 
 drop-table
diff --git a/tests/test_api_write.py b/tests/test_api_write.py
index 9caf9fdf..30cbfbab 100644
--- a/tests/test_api_write.py
+++ b/tests/test_api_write.py
@@ -1349,3 +1349,77 @@ async def test_method_not_allowed(ds_write, path):
         "ok": False,
         "error": "Method not allowed",
     }
+
+
+@pytest.mark.asyncio
+async def test_create_uses_alter_by_default_for_new_table(ds_write):
+    token = write_token(ds_write)
+    response = await ds_write.client.post(
+        "/data/-/create",
+        json={
+            "table": "new_table",
+            "rows": [
+                {
+                    "name": "Row 1",
+                }
+            ]
+            * 100
+            + [
+                {"name": "Row 2", "extra": "Extra"},
+            ],
+            "pk": "id",
+        },
+        headers=_headers(token),
+    )
+    assert response.status_code == 201
+    event = last_event(ds_write)
+    assert event.name == "create-table"
+
+
+@pytest.mark.asyncio
+@pytest.mark.parametrize("has_alter_permission", (True,))  # False))
+async def test_create_using_alter_against_existing_table(
+    ds_write, has_alter_permission
+):
+    token = write_token(
+        ds_write, permissions=["ir", "ct"] + (["at"] if has_alter_permission else [])
+    )
+    # First create the table
+    response = await ds_write.client.post(
+        "/data/-/create",
+        json={
+            "table": "new_table",
+            "rows": [
+                {
+                    "name": "Row 1",
+                }
+            ],
+            "pk": "id",
+        },
+        headers=_headers(token),
+    )
+    assert response.status_code == 201
+    # Now try to insert more rows using /-/create with alter=True
+    response2 = await ds_write.client.post(
+        "/data/-/create",
+        json={
+            "table": "new_table",
+            "rows": [{"name": "Row 2", "extra": "extra"}],
+            "pk": "id",
+            "alter": True,
+        },
+        headers=_headers(token),
+    )
+    if not has_alter_permission:
+        assert response2.status_code == 403
+        assert response2.json() == {
+            "ok": False,
+            "errors": ["Permission denied - need alter-table"],
+        }
+    else:
+        assert response2.status_code == 201
+        # It should have altered the table
+        event = last_event(ds_write)
+        assert event.name == "alter-table"
+        assert "extra" not in event.before_schema
+        assert "extra" in event.after_schema