Standard technical solutions are not cost-effective for many small hydropower sites. This study aims to demonstrate the workflow for the tailor-made variable-speed axial propeller turbine and provide proof of this concept. The turbine is designed to meet the site’s specific space limitations and operating range needs. The runner shape is adjusted to the variable-speed operation and defined hydraulic profile using a parametric geometry model and CFD-based optimization. The variable-speed propeller turbine shows excellent flow control while keeping the mechanical design simple. The tailor-made approach minimizes construction costs using existing structures and is highly suitable for mini-hydropower applications. The prototype—an atypical turbine designed for highly restricted space and installed on-site—serves as proof of the concept. The findings on the design of axial variable-speed turbines are presented.